Provider Demographics
NPI:1679292627
Name:AKINKUADE, KANYINSOLA
Entity Type:Individual
Prefix:
First Name:KANYINSOLA
Middle Name:
Last Name:AKINKUADE
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 1:8 QUAILS NEST CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5604
Mailing Address - Country:US
Mailing Address - Phone:443-608-3844
Mailing Address - Fax:
Practice Address - Street 1:8508 LOCH RAVEN BLVD STE I
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2354
Practice Address - Country:US
Practice Address - Phone:443-469-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist