Healthcare Provider Details

I. General information

NPI: 1467323600
Provider Name (Legal Business Name): OLUSEUN DETUTU OJO CNA, HHA, CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6492 LANDOVER RD STE C8
CHEVERLY MD
20785-1455
US

IV. Provider business mailing address

6492 LANDOVER RD STE C8
CHEVERLY MD
20785-1455
US

V. Phone/Fax

Practice location:
  • Phone: 442-682-3773
  • Fax: --
Mailing address:
  • Phone: 442-682-3773
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200005380
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00204332
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: