Healthcare Provider Details

I. General information

NPI: 1144994450
Provider Name (Legal Business Name): ADESOLA AYANLAJA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13204 MILES CT APT 402
LAUREL MD
20708-2031
US

IV. Provider business mailing address

13204 MILES CT APT 402
LAUREL MD
20708-2031
US

V. Phone/Fax

Practice location:
  • Phone: 240-544-8937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200002715
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00172346
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: