Healthcare Provider Details

I. General information

NPI: 1558276030
Provider Name (Legal Business Name): MS. OPEYEMI ABOSEDE ODUMERU I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 BRANCH AVENUE. SUITE 309. TEMPLE HILLS MD.
TEMPLE HILLS MD
20748
US

IV. Provider business mailing address

7791 MONTGOMERY MEWS CT
SEVERN MD
21144-1245
US

V. Phone/Fax

Practice location:
  • Phone: 301-909-0123
  • Fax:
Mailing address:
  • Phone: 301-909-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR160809
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: