Provider Demographics
NPI:1710669130
Name:OYETUNJI, ENIOLA A
Entity Type:Individual
Prefix:
First Name:ENIOLA
Middle Name:A
Last Name:OYETUNJI
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 1:3503 FALLING RUN RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2917
Mailing Address - Country:US
Mailing Address - Phone:240-354-4337
Mailing Address - Fax:
Practice Address - Street 1:3503 FALLING RUN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2917
Practice Address - Country:US
Practice Address - Phone:240-354-4337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator