Provider Demographics
NPI:1497097489
Name:FAGBUYI, OLUWAFEMI
Entity Type:Individual
Prefix:
First Name:OLUWAFEMI
Middle Name:
Last Name:FAGBUYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 KENNEDY ST NW STE 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5270
Mailing Address - Country:US
Mailing Address - Phone:202-450-4122
Mailing Address - Fax:202-450-4123
Practice Address - Street 1:143 KENNEDY ST NW STE 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5270
Practice Address - Country:US
Practice Address - Phone:202-450-4122
Practice Address - Fax:202-450-4123
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide