Provider Demographics
NPI:1548824204
Name:GBADAMOSI, ADIJAT YEMISI
Entity type:Individual
Prefix:
First Name:ADIJAT
Middle Name:YEMISI
Last Name:GBADAMOSI
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 1:2512 24TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2126
Mailing Address - Country:US
Mailing Address - Phone:202-832-8340
Mailing Address - Fax:
Practice Address - Street 1:12804 COTTONWOOD CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5625
Practice Address - Country:US
Practice Address - Phone:301-806-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14254374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide