Provider Demographics
NPI:1255853362
Name:FASHOLA, OLUWATOSIN
Entity Type:Individual
Prefix:MS
First Name:OLUWATOSIN
Middle Name:
Last Name:FASHOLA
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 1:3209 HIGHLAND PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3232
Mailing Address - Country:US
Mailing Address - Phone:202-363-8777
Mailing Address - Fax:
Practice Address - Street 1:1100 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6517
Practice Address - Country:US
Practice Address - Phone:571-839-9487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor