Provider Demographics
NPI:1750279618
Name:SOGBESAN, OLUFUNMILAYO TITILOLA (PMHNP)
Entity type:Individual
Prefix:
First Name:OLUFUNMILAYO
Middle Name:TITILOLA
Last Name:SOGBESAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15204 DUNLEIGH DR # A
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3252
Mailing Address - Country:US
Mailing Address - Phone:240-821-0298
Mailing Address - Fax:
Practice Address - Street 1:15204 DUNLEIGH DR # A
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3252
Practice Address - Country:US
Practice Address - Phone:240-821-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226403363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health