Healthcare Provider Details

I. General information

NPI: 1710686878
Provider Name (Legal Business Name): ADESEWA ADESOLA OTINNIYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
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

2909 BURROWS LN
ELLICOTT CITY MD
21043-3682
US

V. Phone/Fax

Practice location:
  • Phone: 202-318-0179
  • Fax:
Mailing address:
  • Phone: 240-877-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: