Healthcare Provider Details

I. General information

NPI: 1316336498
Provider Name (Legal Business Name): SYLIVIA ACHOLONU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 VILLAGE ST
WALDORF MD
20602-1838
US

IV. Provider business mailing address

14114 JONES BRIDGE RD
UPPER MARLBORO MD
20774-8860
US

V. Phone/Fax

Practice location:
  • Phone: 301-377-9800
  • Fax:
Mailing address:
  • Phone: 301-377-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR181388
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR181388
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: