MEDICARE: RASIDAT ADEOLA ADENLOLA

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	235Z00000X	Speech-Language Pathologist
2	235Z00000X	Speech-Language Pathologist	2203001051	VA
3	235Z00000X	Speech-Language Pathologist	10946	MD

General Provider Information

NPI Number	:	1972250082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RASIDAT ADEOLA ADENLOLA

Provider Business Mailing Address
First Line	:	6601 MELVILLE ST APT 243
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-2471
Country	:	US
Telephone Number	:	516-708-7893
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 MELVILLE ST APT 243
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-2471
Country	:	US
Telephone Number	:	516-708-7893
Fax Number	:

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

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	12/04/2025

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Directions to “ RASIDAT ADEOLA ADENLOLA ” Practice Location

Language	Start Address	Practice Location

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