Provider Demographics
NPI:1619635349
Name:OJO, STELLA OMOLADE
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:OMOLADE
Last Name:OJO
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 1:746 FIELDSTONE DR NE APT 201
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4779
Mailing Address - Country:US
Mailing Address - Phone:703-863-9892
Mailing Address - Fax:
Practice Address - Street 1:746 FIELDSTONE DR NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4778
Practice Address - Country:US
Practice Address - Phone:703-863-9892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180412363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics