Healthcare Provider Details

I. General information

NPI: 1770418709
Provider Name (Legal Business Name): IBUKUNOLUWA ADEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9770 GROFFS MILL DR
OWINGS MILLS MD
21117-6341
US

IV. Provider business mailing address

9717 BON HAVEN LN
OWINGS MILLS MD
21117-7410
US

V. Phone/Fax

Practice location:
  • Phone: 410-497-6250
  • Fax:
Mailing address:
  • Phone: 410-314-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: