{
"Npi": {
"NPI": "1205550027",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FAJOLU",
"FirstName": "ADETOUN",
"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": "62 MARYLAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FREEPORT",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11520-2030",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-503-0947",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1 FARMINGDALE ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEST BABYLON",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11704",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-669-5355",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/27/2022",
"LastUpdateDate": "01/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "F405956-01",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "699291-01",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}