Healthcare Provider Details

I. General information

NPI: 1952061335
Provider Name (Legal Business Name): DR. AGNES ABIOLA OLUWATOYIN AWOMOYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 VINCENT PL
MC LEAN VA
22101-3614
US

IV. Provider business mailing address

34049 WELBOURNE RD
UPPERVILLE VA
20184-3121
US

V. Phone/Fax

Practice location:
  • Phone: 540-326-2468
  • Fax:
Mailing address:
  • Phone: 540-326-2478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019018568
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: