Provider Demographics
NPI:1265025969
Name:FADAIRO, OLAOLU (NP)
Entity Type:Individual
Prefix:MR
First Name:OLAOLU
Middle Name:
Last Name:FADAIRO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 KINGS HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2010
Mailing Address - Country:US
Mailing Address - Phone:301-648-9340
Mailing Address - Fax:
Practice Address - Street 1:1007 KINGS HEATHER DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2010
Practice Address - Country:US
Practice Address - Phone:301-648-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1002211363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health