Provider Demographics
NPI:1629561584
Name:OSEFO, MELANIE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:OSEFO
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 1:2411 CROFTON LN STE 14A
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1336
Mailing Address - Country:US
Mailing Address - Phone:240-267-9595
Mailing Address - Fax:240-363-2266
Practice Address - Street 1:2411 CROFTON LN STE 14A
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1336
Practice Address - Country:US
Practice Address - Phone:240-267-9595
Practice Address - Fax:240-363-2266
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2022067063363LP0808X
MDR212770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily