Basic Information
| Provider Information | |||||||||
| NPI: | 1891155958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADEYANJU | ||||||||
| FirstName: | IYABO | ||||||||
| MiddleName: | AJOKE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | SPECIAL EDUCATOR | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DUDUYEMI | ||||||||
| OtherFirstName: | IYABO | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2510 WESTCHESTER AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104613585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185975558 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2510 WESTCHESTER AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104613585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185975558 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2016 | ||||||||
| LastUpdateDate: | 03/02/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 973688151 | NY | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.