Healthcare Provider Details

I. General information

NPI: 1538745633
Provider Name (Legal Business Name): AYODEJI M BAKINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 BRIGHTSEAT RD # 12
HYATTSVILLE MD
20785-3764
US

IV. Provider business mailing address

1612 BRIGHTSEAT RD # 12
HYATTSVILLE MD
20785-3764
US

V. Phone/Fax

Practice location:
  • Phone: 240-310-6263
  • Fax: 410-946-2010
Mailing address:
  • Phone: 240-310-6263
  • Fax: 410-946-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA0017954
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: