MEDICARE: MANDU OTUYELU

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1497697254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDU OTUYELU

Provider Business Mailing Address
First Line	:	11720 BELTSVILLE DR STE 500A15
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-3166
Country	:	US
Telephone Number	:	240-226-2834
Fax Number	:	301-889-9735

Provider Business Practice Location Address
First Line	:	11720 BELTSVILLE DR # 500A15
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-3166
Country	:	US
Telephone Number	:	240-226-2834
Fax Number	:	301-889-9735

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ MANDU OTUYELU ” Practice Location

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