Provider Demographics
NPI:1689369381
Name:OLOLADE, OYEBUKUNOLA ADEDOYIN
Entity Type:Individual
Prefix:
First Name:OYEBUKUNOLA
Middle Name:ADEDOYIN
Last Name:OLOLADE
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 1:6206 ROSSVILLE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8066
Mailing Address - Country:US
Mailing Address - Phone:804-728-9570
Mailing Address - Fax:804-275-1842
Practice Address - Street 1:6206 ROSSVILLE CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8066
Practice Address - Country:US
Practice Address - Phone:804-728-9570
Practice Address - Fax:804-275-1842
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6721-08-011251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services