Healthcare Provider Details

I. General information

NPI: 1235076787
Provider Name (Legal Business Name): FATIMA BINTA MODUPEOLA ALALADE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 THOMAS PROSPECT DR
BOWIE MD
20720-3374
US

IV. Provider business mailing address

12300 THOMAS PROSPECT DR
BOWIE MD
20720-3374
US

V. Phone/Fax

Practice location:
  • Phone: 202-716-2816
  • Fax:
Mailing address:
  • Phone: 202-716-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026000751
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: