Healthcare Provider Details

I. General information

NPI: 1174440127
Provider Name (Legal Business Name): SHAKIRAT ADIGUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 W FAYETTE ST
BALTIMORE MD
21223-1938
US

IV. Provider business mailing address

2538 VERONA PL UNIT A
ELLICOTT CITY MD
21042-4873
US

V. Phone/Fax

Practice location:
  • Phone: 410-727-3947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28441
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: