MEDICARE: ADEBUKOLA MARY OBAYANDE

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	374U00000X	Home Health Aide
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1952673683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEBUKOLA MARY OBAYANDE

Provider Business Mailing Address
First Line	:	9810 CRANAPPLE COURT
Second Line	:
City	:	SPRINGDALE
State	:	MD
Zip	:	20774
Country	:	US
Telephone Number	:	240-398-1701
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 BRYAN PLACE
Second Line	:
City	:	SOUTH EAST
State	:	DC
Zip	:	20020-1616
Country	:	US
Telephone Number	:	202-894-6811
Fax Number	:

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

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	06/26/2023

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