Provider Demographics
NPI:1821477134
Name:OKEDIRAN, DIDEOLU
Entity Type:Individual
Prefix:
First Name:DIDEOLU
Middle Name:
Last Name:OKEDIRAN
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 1:3811 64TH AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1846
Mailing Address - Country:US
Mailing Address - Phone:518-683-1702
Mailing Address - Fax:
Practice Address - Street 1:3811 64TH AVE APT 203
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1846
Practice Address - Country:US
Practice Address - Phone:518-683-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00433049171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor