Provider Demographics
NPI:1215602966
Name:OSAYANDE, KENYATTA DADA
Entity Type:Individual
Prefix:
First Name:KENYATTA
Middle Name:DADA
Last Name:OSAYANDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 RONNIE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-2427
Mailing Address - Country:US
Mailing Address - Phone:804-467-9118
Mailing Address - Fax:
Practice Address - Street 1:3605 RONNIE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2427
Practice Address - Country:US
Practice Address - Phone:804-467-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide