Healthcare Provider Details

I. General information

NPI: 1033872361
Provider Name (Legal Business Name): KHADIJAT OLADOYIN ADEBIYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8509 CROOKED TREE LN
LAUREL MD
20724-2489
US

IV. Provider business mailing address

5100 BUCKEYSTOWN PIKE STE 250
FREDERICK MD
21704-8344
US

V. Phone/Fax

Practice location:
  • Phone: 240-565-7062
  • Fax:
Mailing address:
  • Phone: 240-831-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193924
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: