Provider Demographics
NPI:1376132019
Name:FAKINLEDE, YETUNDE O (PMHNP)
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:O
Last Name:FAKINLEDE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BIRKENHEAD CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4893
Mailing Address - Country:US
Mailing Address - Phone:240-413-3431
Mailing Address - Fax:
Practice Address - Street 1:1447 YORK RD STE 506
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6054
Practice Address - Country:US
Practice Address - Phone:410-825-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210560363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health