Provider Demographics
NPI:1225650872
Name:OLUFADE, CHRISTIANAH T
Entity Type:Individual
Prefix:
First Name:CHRISTIANAH
Middle Name:T
Last Name:OLUFADE
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 1:4920 NIAGARA RD STE 107
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1121
Mailing Address - Country:US
Mailing Address - Phone:301-755-7685
Mailing Address - Fax:
Practice Address - Street 1:4920 NIAGARA RD STE 107
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1121
Practice Address - Country:US
Practice Address - Phone:301-755-7685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health