Individual provider Active NPI

Abisola Kafilat Adejayan

  • Home Health Aide
  • Laurel, MD
National Provider Identifier
1124695440
Registry record updated Jun 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AideTaxonomy code 374U00000X
License
NA0000813083 Issued in DC
Practice address
8316 Green Grass Rd
Laurel, MD 20724-3909
Phone
(803) 463-4940
NPI assigned
Jun 6, 2021
Last updated
Jun 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Aide 374U00000X NA0000813083 DC Primary

Addresses

Primary practice location

8316 Green Grass Rd
Laurel, MD 20724-3909

Mailing address

8316 Green Grass Rd
Laurel, MD 20724-3909
Phone (803) 463-4940

Other identifiers 1

IdentifierTypeStateIssuer
NA0000813083OtherDCNURSING ASSISTANT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
NA0000813083DCMDHome Health Aide

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622937600000",
    "number": "1124695440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8316 GREEN GRASS RD",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207243909",
            "telephone_number": "803-463-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8316 GREEN GRASS RD",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207243909",
            "telephone_number": "803-463-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEJAYAN",
        "first_name": "ABISOLA",
        "middle_name": "KAFILAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-06",
        "last_updated": "2021-06-06",
        "certification_date": "2021-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "DC",
            "license": "NA0000813083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING ASSISTANT",
            "identifier": "NA0000813083",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.