Provider Demographics
NPI:1487085866
Name:AJIBODE, JIMMY
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:AJIBODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 57TH AVE
Mailing Address - Street 2:APT 304
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1626
Mailing Address - Country:US
Mailing Address - Phone:240-640-9559
Mailing Address - Fax:
Practice Address - Street 1:5032 57TH AVE
Practice Address - Street 2:APT 304
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1626
Practice Address - Country:US
Practice Address - Phone:240-640-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide