Healthcare Provider Details

I. General information

NPI: 1598673733
Provider Name (Legal Business Name): OCEANLIGHT SUPPORT SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15738 ENSLEIGH LN
BOWIE MD
20716-3236
US

IV. Provider business mailing address

15738 ENSLEIGH LN
BOWIE MD
20716-3236
US

V. Phone/Fax

Practice location:
  • Phone: 240-879-9385
  • Fax:
Mailing address:
  • Phone: 240-879-9385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY OLUSEGUN QUADRI
Title or Position: CEO
Credential:
Phone: 240-879-9385