{
"Npi": {
"NPI": "1154876415",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FADEYI",
"FirstName": "AYOOLA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1446 BELLSMITH DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROSWELL",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30076-0921",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "917-445-2420",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1446 BELLSMITH DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROSWELL",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30076-0921",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "917-445-2420",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/16/2016",
"LastUpdateDate": "11/05/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "08/07/2020",
"NPIReactivationDate": "11/05/2024",
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225C00000X",
"TaxonomyName": "Rehabilitation Counselor",
"LicenseNumber": "34147",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "347C00000X",
"TaxonomyName": "Private Vehicle",
"LicenseNumber": "055852853",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}