Healthcare Provider Details

I. General information

NPI: 1255762696
Provider Name (Legal Business Name): DESMINA AYODELE FRIDAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 09/26/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 WASHINGTON BLVD FL 3
ARLINGTON VA
22204-5718
US

IV. Provider business mailing address

2120 WASHINGTON BLVD FL 3
ARLINGTON VA
22204-5718
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-5150
  • Fax:
Mailing address:
  • Phone: 703-228-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number980185
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101282745
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: