Provider Demographics
NPI:1043748601
Name:ONASANYA, OLUWAKEMI
Entity Type:Individual
Prefix:
First Name:OLUWAKEMI
Middle Name:
Last Name:ONASANYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 HARFORD SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2209
Mailing Address - Country:US
Mailing Address - Phone:410-710-8386
Mailing Address - Fax:
Practice Address - Street 1:1341 HARFORD SQUARE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-2209
Practice Address - Country:US
Practice Address - Phone:410-710-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker