Healthcare Provider Details

I. General information

NPI: 1083528665
Provider Name (Legal Business Name): OLUWATOYIN LIBERTY AJENIFUJA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 COLONEL ASHTON PL
UPPER MARLBORO MD
20772-2881
US

IV. Provider business mailing address

4119 HOWARD RD
BELTSVILLE MD
20705-2683
US

V. Phone/Fax

Practice location:
  • Phone: 301-379-9654
  • Fax: 240-377-0226
Mailing address:
  • Phone: 240-855-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: