Healthcare Provider Details

I. General information

NPI: 1912719857
Provider Name (Legal Business Name): RASHEEDAH BIMBO OGUNBIYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BALTIMORE BLVD STE A
FINKSBURG MD
21048-1751
US

IV. Provider business mailing address

9722 GROFFS MILL DR
OWINGS MILLS MD
21117-6341
US

V. Phone/Fax

Practice location:
  • Phone: 410-900-9929
  • Fax:
Mailing address:
  • Phone: 443-722-7136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR234513
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: