Healthcare Provider Details

I. General information

NPI: 1205547262
Provider Name (Legal Business Name): OLADOYIN OLADAYO ADEKOLA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 OLD FREDERICK RD STE 6
BALTIMORE MD
21229-2126
US

IV. Provider business mailing address

9220 SEWALL AVE
LAUREL MD
20723-1889
US

V. Phone/Fax

Practice location:
  • Phone: 240-423-1872
  • Fax:
Mailing address:
  • Phone: 240-423-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR209115
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR209115
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: