Provider Demographics
NPI:1629333695
Name:SHITTU, SULIAT SUBUOLA
Entity Type:Individual
Prefix:MISS
First Name:SULIAT
Middle Name:SUBUOLA
Last Name:SHITTU
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 1:5921 CHERRYWOOD TER APT 301
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4279
Mailing Address - Country:US
Mailing Address - Phone:240-338-4979
Mailing Address - Fax:
Practice Address - Street 1:5921 CHERRYWOOD TER APT 301
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4279
Practice Address - Country:US
Practice Address - Phone:240-338-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program