Provider Demographics
NPI:1023664190
Name:ADAMOLEKUN, COLLETTE DIONNE
Entity type:Individual
Prefix:MS
First Name:COLLETTE
Middle Name:DIONNE
Last Name:ADAMOLEKUN
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 1:1502 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1632
Mailing Address - Country:US
Mailing Address - Phone:443-214-2990
Mailing Address - Fax:
Practice Address - Street 1:1502 SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1632
Practice Address - Country:US
Practice Address - Phone:443-214-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW19261668251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health