Healthcare Provider Details

I. General information

NPI: 1669157160
Provider Name (Legal Business Name): MAYPEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 PLACID CT APTD
ODENTON MD
21113-1440
US

IV. Provider business mailing address

502 PLACID CT APT D
ODENTON MD
21113-1440
US

V. Phone/Fax

Practice location:
  • Phone: 862-231-7932
  • Fax:
Mailing address:
  • Phone: 862-231-7932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. OLAYINKA AJIBOLA A ABAYOMI-SALAKO
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 267-671-9317