Healthcare Provider Details

I. General information

NPI: 1477497865
Provider Name (Legal Business Name): ADEYOSOLA OLUDARA OYEWALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 FALL RIDGE WAY
GAMBRILLS MD
21054-1454
US

IV. Provider business mailing address

906 FALL RIDGE WAY
GAMBRILLS MD
21054-1454
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-2887
  • Fax:
Mailing address:
  • Phone: 240-413-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006176
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: