MEDICARE: OLUWASEYI A OLADUNJOYE-PHILLIPS PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	196772	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	196772	MD

General Provider Information

NPI Number	:	1427313980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWASEYI A OLADUNJOYE-PHILLIPS PMHNP

Provider Business Mailing Address
First Line	:	126 PHILOSOPHERS TER
Second Line	:
City	:	CHESTERTOWN
State	:	MD
Zip	:	21620-1715
Country	:	US
Telephone Number	:	443-215-5353
Fax Number	:	833-615-2165

Provider Business Practice Location Address
First Line	:	126 PHILOSOPHERS TER
Second Line	:
City	:	CHESTERTOWN
State	:	MD
Zip	:	21620-1715
Country	:	US
Telephone Number	:	443-215-5353
Fax Number	:	833-615-2165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	06/26/2023

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