Healthcare Provider Details

I. General information

NPI: 1891288056
Provider Name (Legal Business Name): AYODELE AKINSUYI AGNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 MAIN ST
FAIRFAX VA
22030-6914
US

IV. Provider business mailing address

10721 MAIN ST
FAIRFAX VA
22030-6914
US

V. Phone/Fax

Practice location:
  • Phone: 757-581-4296
  • Fax:
Mailing address:
  • Phone: 757-581-4296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024184468
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024184468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: