Healthcare Provider Details

I. General information

NPI: 1225965791
Provider Name (Legal Business Name): OLAIDE DEMOKUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13401 GWYNN PARK CT
BRANDYWINE MD
20613-5804
US

IV. Provider business mailing address

13401 GWYNN PARK CT
BRANDYWINE MD
20613-5804
US

V. Phone/Fax

Practice location:
  • Phone: 301-272-0680
  • Fax: 301-272-0680
Mailing address:
  • Phone: 301-272-0680
  • Fax: 301-272-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1056609
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: