Provider Demographics
NPI:1790048361
Name:DANIELS, OMOTAYO SHAWN
Entity Type:Individual
Prefix:
First Name:OMOTAYO
Middle Name:SHAWN
Last Name:DANIELS
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 1:4227 DUNWOOD TER
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1323
Mailing Address - Country:US
Mailing Address - Phone:443-858-1383
Mailing Address - Fax:
Practice Address - Street 1:4227 DUNWOOD TER
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1323
Practice Address - Country:US
Practice Address - Phone:443-858-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000018441041C0700X
VA09040143361041C0700X
MD161071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical