Provider Demographics
NPI:1659039022
Name:ILORI, TITILAYO
Entity Type:Individual
Prefix:
First Name:TITILAYO
Middle Name:
Last Name:ILORI
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 1:547 RIVERSIDE DR STE A
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5369
Mailing Address - Country:US
Mailing Address - Phone:443-755-7517
Mailing Address - Fax:
Practice Address - Street 1:547 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5369
Practice Address - Country:US
Practice Address - Phone:443-755-7517
Practice Address - Fax:443-733-6050
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR192875363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health