Healthcare Provider Details

I. General information

NPI: 1053260422
Provider Name (Legal Business Name): MR. COLLINS TAYO PATIPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10729 VENETIA MAILL CIR APAT2B
SILVER SPRING MD
20901-1592
US

IV. Provider business mailing address

10729 VENETIA MAILL CIR APAT2B
SILVER SPRING MD
20901
US

V. Phone/Fax

Practice location:
  • Phone: 227-254-6543
  • Fax:
Mailing address:
  • Phone: 227-254-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: