Healthcare Provider Details

I. General information

NPI: 1437735859
Provider Name (Legal Business Name): SEUN OYINKANSOLA OGUNSANYA AWATEFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6805 RIVERDALE RD APT 3
RIVERDALE MD
20737-1816
US

IV. Provider business mailing address

4785 DORSEY HALL DR STE 122
ELLICOTT CITY MD
21042-7927
US

V. Phone/Fax

Practice location:
  • Phone: 202-415-4824
  • Fax:
Mailing address:
  • Phone: 202-415-4824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: