Healthcare Provider Details

I. General information

NPI: 1801968599
Provider Name (Legal Business Name): TAHIRA GITTENS ADELEKAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 VALLEY ST
DAYTON OH
45404
US

IV. Provider business mailing address

PO BOX 933432
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-4000
  • Fax: 937-641-4500
Mailing address:
  • Phone: 937-641-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.127565
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number35.127565
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: