Healthcare Provider Details

I. General information

NPI: 1053247460
Provider Name (Legal Business Name): OLAYINKA O. AWONUGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 MARTIN LUTHER KING JR AVE SW STE A2
WASHINGTON DC
20032-4933
US

IV. Provider business mailing address

1444 PANGBOURNE WAY
HANOVER MD
21076-1376
US

V. Phone/Fax

Practice location:
  • Phone: 202-318-0179
  • Fax:
Mailing address:
  • Phone: 301-531-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN500341364
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: