Healthcare Provider Details

I. General information

NPI: 1356276299
Provider Name (Legal Business Name): ADEOLA F AJAYI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PORTER AVE
BUFFALO NY
14201-1032
US

IV. Provider business mailing address

2094 PITKIN AVE
BROOKLYN NY
11207-3509
US

V. Phone/Fax

Practice location:
  • Phone: 917-244-0404
  • Fax:
Mailing address:
  • Phone: 917-244-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number358581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: