Healthcare Provider Details

I. General information

NPI: 1295334894
Provider Name (Legal Business Name): OLAOLUWA AKIN MA, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date: 12/04/2024
Reactivation Date: 08/25/2026

III. Provider practice location address

10530 CAMPUS WAY S # 1309
LARGO MD
20774-1309
US

IV. Provider business mailing address

10530 CAMPUS WAY S # 1309
LARGO MD
20774-1309
US

V. Phone/Fax

Practice location:
  • Phone: 240-444-0176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDX4551
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX4551
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX4551
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: