Provider Demographics
NPI:1710473913
Name:OMOTEYE, FAITH OLUWATUMISE
Entity Type:Individual
Prefix:MISS
First Name:FAITH
Middle Name:OLUWATUMISE
Last Name:OMOTEYE
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 1:3600 55TH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1152
Mailing Address - Country:US
Mailing Address - Phone:202-351-1217
Mailing Address - Fax:
Practice Address - Street 1:3600 55TH AVE APT 8
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1152
Practice Address - Country:US
Practice Address - Phone:202-351-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHHA13787251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health