Provider Demographics
NPI:1407898687
Name:ODEDINA, FOLASHADE O (NP)
Entity Type:Individual
Prefix:
First Name:FOLASHADE
Middle Name:O
Last Name:ODEDINA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:FOLASHADE
Other - Middle Name:
Other - Last Name:SHASANYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2215 LANGHORNE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1121
Mailing Address - Country:US
Mailing Address - Phone:434-455-3047
Mailing Address - Fax:434-948-4918
Practice Address - Street 1:2215 LANGHORNE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1121
Practice Address - Country:US
Practice Address - Phone:434-455-3047
Practice Address - Fax:434-948-4918
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166577363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945441Medicaid
VA004945441Medicaid