Basic Information
| Provider Information | |||||||||
| NPI: | 1629455654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AJAYI-LAMANNA | ||||||||
| FirstName: | OLAYEMI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AJAYI | ||||||||
| OtherFirstName: | OLAYEMI | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 201 CHESTNUT HILL RD | ||||||||
| Address2: | |||||||||
| City: | STAFFORD SPRINGS | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060764005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606848280 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 CHESTNUT HILL RD | ||||||||
| Address2: | |||||||||
| City: | STAFFORD SPRINGS | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060764005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606848280 | ||||||||
| FaxNumber: | 8606848285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2015 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | 66659 | CT | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.