MEDICARE: OLUWASEUN GRACE ADEGBOYE

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		MD

General Provider Information

NPI Number	:	1912839218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWASEUN GRACE ADEGBOYE

Provider Business Mailing Address
First Line	:	7608 GLASER LN
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-6764
Country	:	US
Telephone Number	:	239-687-8843
Fax Number	:

Provider Business Practice Location Address
First Line	:	7608 GLASER LN
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-6764
Country	:	US
Telephone Number	:	239-687-8843
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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