Provider Demographics
NPI:1356817373
Name:OMODEOYE, TAJUDEEN (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:TAJUDEEN
Middle Name:
Last Name:OMODEOYE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 GREENS LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5411 OLD FREDERICK RD STE 8
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-2126
Practice Address - Country:US
Practice Address - Phone:443-315-5007
Practice Address - Fax:443-251-5393
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPENDING363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health