Healthcare Provider Details

I. General information

NPI: 1427976539
Provider Name (Legal Business Name): OLUWASEYI ADEWOLE AJIBADE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 LANDOVER RD APT 203
CHEVERLY MD
20785-1409
US

IV. Provider business mailing address

6415 LANDOVER RD APT 203
CHEVERLY MD
20785-1409
US

V. Phone/Fax

Practice location:
  • Phone: 443-739-8415
  • Fax:
Mailing address:
  • Phone: 443-739-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: