Healthcare Provider Details

I. General information

NPI: 1841812005
Provider Name (Legal Business Name): TDK INTEGRATED HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7102 GLEN PINE ST
GLENN DALE MD
20769-9463
US

IV. Provider business mailing address

7102 GLEN PINE ST
GLENN DALE MD
20769-9463
US

V. Phone/Fax

Practice location:
  • Phone: 301-615-3639
  • Fax: 945-200-5716
Mailing address:
  • Phone: 301-615-3639
  • Fax: 945-200-5617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FUNMILAYO OLUGBEMI
Title or Position: CEO
Credential: PMHNP-BC
Phone: 301-615-3639