MEDICARE: MR. AKINSOLA SESAN OLUWADARE HOME HEALTH AIDE

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	163WH0200X	Home Health Registered Nurse	HHA11693	DC
2	374U00000X	Home Health Aide	HHA11693	DC

General Provider Information

NPI Number	:	1861851420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AKINSOLA SESAN OLUWADARE HOME HEALTH AIDE

Provider Business Mailing Address
First Line	:	6315 LANDOVER ROAD APT 101
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785
Country	:	US
Telephone Number	:	240-906-0729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 FORT STEVENS DR NW APT 5
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-5027
Country	:	US
Telephone Number	:	202-520-9852
Fax Number	:

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

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	09/18/2018

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