Healthcare Provider Details

I. General information

NPI: 1396660379
Provider Name (Legal Business Name): TAYSHEIL ADETUNJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S PROSPECT RD STE 2
BLOOMINGTON IL
61704-4908
US

IV. Provider business mailing address

56 MOONLIGHT CT
MATTESON IL
60443-1282
US

V. Phone/Fax

Practice location:
  • Phone: 224-291-8326
  • 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: