Healthcare Provider Details

I. General information

NPI: 1841129434
Provider Name (Legal Business Name): KEHINDE TOM AYEGUNLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E 21ST ST
BALTIMORE MD
21218-6124
US

IV. Provider business mailing address

521 E 21ST ST
BALTIMORE MD
21218-6124
US

V. Phone/Fax

Practice location:
  • Phone: 445-249-7879
  • Fax:
Mailing address:
  • Phone:
  • 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: