Provider Demographics
NPI:1730906314
Name:BAMISAYE, AYODEJI ADETUNJI
Entity type:Individual
Prefix:MR
First Name:AYODEJI
Middle Name:ADETUNJI
Last Name:BAMISAYE
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 1:1301 STEVENSON BLVD APT 411
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2986
Mailing Address - Country:US
Mailing Address - Phone:510-953-3114
Mailing Address - Fax:
Practice Address - Street 1:1301 STEVENSON BLVD APT 411
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2986
Practice Address - Country:US
Practice Address - Phone:510-953-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician