Healthcare Provider Details

I. General information

NPI: 1114888948
Provider Name (Legal Business Name): MRS. ADERONKE ANTHONIA OLUSUYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 ROXY RUN
CLINTON MD
20735-5881
US

IV. Provider business mailing address

7300 ROXY RUN
CLINTON MD
20735-5881
US

V. Phone/Fax

Practice location:
  • Phone: 202-621-8713
  • Fax:
Mailing address:
  • Phone: 202-621-8713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500022069
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: