Healthcare Provider Details

I. General information

NPI: 1346085495
Provider Name (Legal Business Name): FOLASHADE OMOWUNMI IDOWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2024
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SHANANDALE DR
SILVER SPRING MD
20904-1632
US

IV. Provider business mailing address

3403 DODGE PARK RD APT 303
LANDOVER MD
20785-2009
US

V. Phone/Fax

Practice location:
  • Phone: 202-660-3275
  • Fax:
Mailing address:
  • Phone: 202-660-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00211314
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: