Healthcare Provider Details

I. General information

NPI: 1497317853
Provider Name (Legal Business Name): WAKEELAT A ADEOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 0LD FREDRICK RD SUITE 7
BALTIMORE MD
21229
US

IV. Provider business mailing address

1177 ANNAPOLIS RD STE 233
ODENTON MD
21113
US

V. Phone/Fax

Practice location:
  • Phone: 202-415-0285
  • Fax:
Mailing address:
  • Phone: 202-415-0285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR214863
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: