Healthcare Provider Details

I. General information

NPI: 1538901509
Provider Name (Legal Business Name): ADEBOLAMIDE ADELEKUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-6719
US

IV. Provider business mailing address

2526 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-6719
US

V. Phone/Fax

Practice location:
  • Phone: 443-889-3180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: