Healthcare Provider Details

I. General information

NPI: 1750795407
Provider Name (Legal Business Name): DAMILOLA KEMISOLA FAMILONI N.D, L.AC, M.S(NUTRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 WINSTON CHURCHILL CT
UPPER MARLBORO MD
20772-4849
US

IV. Provider business mailing address

10801 WINSTON CHURCHILL CT
UPPER MARLBORO MD
20772-4849
US

V. Phone/Fax

Practice location:
  • Phone: 301-237-7125
  • Fax:
Mailing address:
  • Phone: 301-237-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02164
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC500199
License Number StateDC
# 6
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP-0051
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: