Provider Demographics
NPI:1053741710
Name:ADEBOYE, VICTORIA C
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:C
Last Name:ADEBOYE
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 1:3419 55TH AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1033
Mailing Address - Country:US
Mailing Address - Phone:240-772-8456
Mailing Address - Fax:
Practice Address - Street 1:820 1ST ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4243
Practice Address - Country:US
Practice Address - Phone:240-772-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-17
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10495374U00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician