Healthcare Provider Details

I. General information

NPI: 1316782675
Provider Name (Legal Business Name): OLUSEYI SHARON AGBAJE CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 BON HAVEN LN
OWINGS MILLS MD
21117-7406
US

IV. Provider business mailing address

9808 BON HAVEN LN
OWINGS MILLS MD
21117-7406
US

V. Phone/Fax

Practice location:
  • Phone: 443-675-8382
  • Fax:
Mailing address:
  • Phone: 443-675-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR217599
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR217599
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR217599
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR217599
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR217599
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: