Healthcare Provider Details

I. General information

NPI: 1346917200
Provider Name (Legal Business Name): TEMITOPE ADEBUSOYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 GREENVIEW DR STE 435
LAUREL MD
20708-3287
US

IV. Provider business mailing address

15711 ENSLEIGH LN
BOWIE MD
20716-3235
US

V. Phone/Fax

Practice location:
  • Phone: 301-675-9644
  • Fax: 301-805-0257
Mailing address:
  • Phone: 301-675-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR211216
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: