Provider Demographics
NPI:1275385890
Name:OYELANA, AYODAPO AYANSIJI
Entity Type:Individual
Prefix:
First Name:AYODAPO
Middle Name:AYANSIJI
Last Name:OYELANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AYODAPO
Other - Middle Name:PETER
Other - Last Name:OYELANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3441 TEWKESBURY RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1095
Mailing Address - Country:US
Mailing Address - Phone:410-963-0413
Mailing Address - Fax:
Practice Address - Street 1:3441 TEWKESBURY RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1095
Practice Address - Country:US
Practice Address - Phone:410-963-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD250801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical