Healthcare Provider Details

I. General information

NPI: 1548101140
Provider Name (Legal Business Name): OLAYINKA OLAMIDE SOGBESAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10264 BALTIMORE NATIONAL PIKE STE B
ELLICOTT CITY MD
21042-3609
US

IV. Provider business mailing address

35 K ST NE
WASHINGTON DC
20002-4216
US

V. Phone/Fax

Practice location:
  • Phone: 443-288-0366
  • Fax:
Mailing address:
  • Phone: 202-839-3500
  • Fax: 202-839-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR66402
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: