Provider Demographics
NPI:1952673683
Name:OBAYANDE, ADEBUKOLA MARY
Entity Type:Individual
Prefix:
First Name:ADEBUKOLA
Middle Name:MARY
Last Name:OBAYANDE
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 1:9810 CRANAPPLE COURT
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:240-398-1701
Mailing Address - Fax:
Practice Address - Street 1:2600 BRYAN PLACE
Practice Address - Street 2:
Practice Address - City:SOUTH EAST
Practice Address - State:DC
Practice Address - Zip Code:20020-1616
Practice Address - Country:US
Practice Address - Phone:202-894-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide