Healthcare Provider Details

I. General information

NPI: 1720928856
Provider Name (Legal Business Name): MR. OLUWADAMILOLA KAYODE FAJEMIROKUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 S WALTER REED DR UNIT A
ARLINGTON VA
22206-1270
US

IV. Provider business mailing address

2715 S WALTER REED DR UNIT A
ARLINGTON VA
22206-1270
US

V. Phone/Fax

Practice location:
  • Phone: 571-400-8722
  • Fax:
Mailing address:
  • Phone: 571-400-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: