Provider Demographics
NPI:1861434169
Name:DIPEOLU, ABIOLA (PHD)
Entity type:Individual
Prefix:
First Name:ABIOLA
Middle Name:
Last Name:DIPEOLU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 BALDY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14260-1000
Mailing Address - Country:US
Mailing Address - Phone:716-836-6045
Mailing Address - Fax:
Practice Address - Street 1:409 BALDY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14260-1000
Practice Address - Country:US
Practice Address - Phone:716-836-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1061103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral