Healthcare Provider Details

I. General information

NPI: 1073292843
Provider Name (Legal Business Name): MS. ABOSEDE CELINAH OLAJUYIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10209 RUNNING BROOK LN UPPR MARLBORO
UPPER MARLBORO MD
20772-6657
US

IV. Provider business mailing address

10209 RUNNING BROOK LN UPPR MARLBORO
UPPER MARLBORO MD
20772-6657
US

V. Phone/Fax

Practice location:
  • Phone: 130-185-1942
  • Fax:
Mailing address:
  • Phone: 301-364-8916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCNA20192136
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00182475
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: