Provider Demographics
NPI:1619224573
Name:ODUKOYA, ABIMBOLA (DO)
Entity Type:Individual
Prefix:DR
First Name:ABIMBOLA
Middle Name:
Last Name:ODUKOYA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 KING CENTRE DR STE 646
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5755
Mailing Address - Country:US
Mailing Address - Phone:703-962-1321
Mailing Address - Fax:
Practice Address - Street 1:5680 KING CENTRE DR # 646
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5757
Practice Address - Country:US
Practice Address - Phone:703-962-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022054002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry