Healthcare Provider Details

I. General information

NPI: 1184263345
Provider Name (Legal Business Name): AMINA MOHAMMED SALIUOKEOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2020
Last Update Date: 06/30/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 ANNAPOLIS RD
NEW CARROLLTON MD
20784-3016
US

IV. Provider business mailing address

1302 QUIET LAKE CV
CROFTON MD
21114-1876
US

V. Phone/Fax

Practice location:
  • Phone: 301-577-6222
  • Fax:
Mailing address:
  • Phone: 301-792-4853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR213314
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF12190698
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: