Healthcare Provider Details

I. General information

NPI: 1215543418
Provider Name (Legal Business Name): ABIMBOLA AYODELE OLOYEDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 E BONIWOOD TURN # MD20735
CLINTON MD
20735-4828
US

IV. Provider business mailing address

5848 E BONIWOOD TURN # MD20735
CLINTON MD
20735-4828
US

V. Phone/Fax

Practice location:
  • Phone: 973-415-4733
  • Fax:
Mailing address:
  • Phone: 973-415-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberA00175715
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: