Healthcare Provider Details

I. General information

NPI: 1255249348
Provider Name (Legal Business Name): BUSHIRAT ADEOLA ELEGBEDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 CAPE HENRY AVE
NORFOLK VA
23513-4550
US

IV. Provider business mailing address

3619 CAPE HENRY AVE
NORFOLK VA
23513-4550
US

V. Phone/Fax

Practice location:
  • Phone: 757-698-8091
  • Fax: 757-698-8091
Mailing address:
  • Phone: 757-698-8091
  • Fax: 757-698-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number0001333112
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: