Healthcare Provider Details

I. General information

NPI: 1669348421
Provider Name (Legal Business Name): OROBOLA OKUSANYA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 RITCHIE HWY
SEVERNA PARK MD
21146-3916
US

IV. Provider business mailing address

1251 W CENTRAL AVE STE 104
DAVIDSONVILLE MD
21035-2321
US

V. Phone/Fax

Practice location:
  • Phone: 301-346-2201
  • Fax:
Mailing address:
  • Phone: 240-463-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR182275
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: