Provider Demographics
NPI:1871839019
Name:OYEBODE, SEGUN O
Entity Type:Individual
Prefix:
First Name:SEGUN
Middle Name:O
Last Name:OYEBODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5616
Mailing Address - Country:US
Mailing Address - Phone:202-413-7296
Mailing Address - Fax:
Practice Address - Street 1:5952 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4824
Practice Address - Country:US
Practice Address - Phone:240-833-3920
Practice Address - Fax:833-728-0364
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224488363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health