MEDICARE: MRS. ADELANKE ADEGOROYE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1275945214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADELANKE ADEGOROYE

Provider Business Mailing Address
First Line	:	2621 NICHOLSON ST APT 201
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-2654
Country	:	US
Telephone Number	:	202-706-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	9905 HARBOR AVE
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-2125
Country	:	US
Telephone Number	:	240-595-5454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2014
Last Update Date	:	05/26/2014

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