=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275945214
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ADELANKE ADEGOROYE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2014
-----------------------------------------------------
Last Update Date | 05/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9905 HARBOR AVE
-----------------------------------------------------
City | GLENN DALE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20769-2125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-595-5454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2621 NICHOLSON ST APT 201
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20782-2654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-706-0463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------