Healthcare Provider Details

I. General information

NPI: 1801657523
Provider Name (Legal Business Name): CELESTINA OKUNDAYE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 11/27/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 RIVERSIDE DRIVE
SALISBURY MD
21801
US

IV. Provider business mailing address

547 RIVERSIDE DRIVE
SALISBURY MD
21801
US

V. Phone/Fax

Practice location:
  • Phone: 443-355-7517
  • Fax:
Mailing address:
  • Phone: 240-688-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023206764
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: