Provider Demographics
NPI:1518564186
Name:ILUFOYE- OJOMU, BOLADE SHERIFAT
Entity type:Individual
Prefix:
First Name:BOLADE SHERIFAT
Middle Name:
Last Name:ILUFOYE- OJOMU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 DODGE PARK RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2004
Mailing Address - Country:US
Mailing Address - Phone:347-571-4136
Mailing Address - Fax:
Practice Address - Street 1:3401 DODGE PARK RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2004
Practice Address - Country:US
Practice Address - Phone:347-571-4136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00172023Medicaid