Healthcare Provider Details

I. General information

NPI: 1609714344
Provider Name (Legal Business Name): RABIAT OLUWAJENSORIRE AJAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST
NORWALK CT
06850-3815
US

IV. Provider business mailing address

1208 BROAD ST APT 101
BRIDGEPORT CT
06604-4107
US

V. Phone/Fax

Practice location:
  • Phone: 929-280-7213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number26NR24461600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: