Healthcare Provider Details

I. General information

NPI: 1952067878
Provider Name (Legal Business Name): FUNMILAYO RITA FASHOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

5324 THOMAS SIM LEE TER
UPPER MARLBORO MD
20772-7422
US

V. Phone/Fax

Practice location:
  • Phone: 202-279-5580
  • Fax:
Mailing address:
  • Phone: 301-433-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN1025198
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR197537
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1025198
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: