Healthcare Provider Details

I. General information

NPI: 1194640995
Provider Name (Legal Business Name): BUSOYE ADEYANJU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

9305 MASTER DERBY DR
RANDALLSTOWN MD
21133-2720
US

IV. Provider business mailing address

9305 MASTER DERBY DR
RANDALLSTOWN MD
21133-2720
US

V. Phone/Fax

Practice location:
  • Phone: 443-210-5718
  • Fax:
Mailing address:
  • Phone: 443-210-5718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA20006824
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: