Individual
MR. AYODEJI BAMIDELE OLAWALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
80 SEYMOUR ST, HARTFORD, CT 06102-8000
(860) 972-2629
Mailing address
11715 BASSWOOD DR, LAUREL, MD 20708-3167
(301) 905-2947
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10362
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R210564
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598395725
—
CT
Enumeration date
01/15/2020
Last updated
12/05/2024
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