Healthcare Provider Details

I. General information

NPI: 1477114395
Provider Name (Legal Business Name): ABIMBOLA O OLADOKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 AVIS DR
UPPER MARLBORO MD
20774-2287
US

IV. Provider business mailing address

3411 DODGE PARK RD APT 102
HYATTSVILLE MD
20785-2025
US

V. Phone/Fax

Practice location:
  • Phone: 240-615-7863
  • Fax:
Mailing address:
  • Phone: 240-615-7863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14504
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: