Healthcare Provider Details

I. General information

NPI: 1780258129
Provider Name (Legal Business Name): ADEBISI S ADEBUTU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 LINCOLN RD NE APT 11
WASHINGTON DC
20002-1154
US

IV. Provider business mailing address

38 47TH ST SE
WASHINGTON DC
20019-8411
US

V. Phone/Fax

Practice location:
  • Phone: 202-925-7316
  • Fax:
Mailing address:
  • Phone: 202-925-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200001878
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: