Provider Demographics
NPI:1407495138
Name:FASINA, TITILAYO IRETIOLA
Entity Type:Individual
Prefix:
First Name:TITILAYO
Middle Name:IRETIOLA
Last Name:FASINA
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 1:3235 75TH AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1928
Mailing Address - Country:US
Mailing Address - Phone:346-218-6314
Mailing Address - Fax:
Practice Address - Street 1:3235 75TH AVE APT 202
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-1928
Practice Address - Country:US
Practice Address - Phone:240-838-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide