Healthcare Provider Details

I. General information

NPI: 1548521784
Provider Name (Legal Business Name): KEHINDE OGUNDEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6551 PENNSYLVANIA AVE APT 204
FORESTVILLE MD
20747-3049
US

IV. Provider business mailing address

6551 PENNSYLVANIA AVE APT 204
FORESTVILLE MD
20747-3049
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-0935
  • Fax: 202-545-0934
Mailing address:
  • Phone: 202-545-0935
  • Fax: 202-545-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA4724
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: