Healthcare Provider Details

I. General information

NPI: 1821902339
Provider Name (Legal Business Name): MODUPE A ADEBAYO-DADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 MALLARD DR STE 210
LAUREL MD
20708-3199
US

IV. Provider business mailing address

9811 MALLARD DR STE 210
LAUREL MD
20708-3199
US

V. Phone/Fax

Practice location:
  • Phone: 301-237-2563
  • Fax: 443-378-8715
Mailing address:
  • Phone: 301-237-2563
  • Fax: 443-378-8715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR159659
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: