Provider Demographics
NPI:1255515110
Name:AKINNUOYE, IYABO ALIMOT
Entity type:Individual
Prefix:
First Name:IYABO
Middle Name:ALIMOT
Last Name:AKINNUOYE
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 1:516A SOUTH CONKLING STREET
Mailing Address - Street 2:DYNAMIC HEALTH CARE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224
Mailing Address - Country:US
Mailing Address - Phone:410-864-8874
Mailing Address - Fax:410-864-8051
Practice Address - Street 1:516 SOUTH CONKLING STREET
Practice Address - Street 2:DYNAMIC HEALTH CARE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-864-8874
Practice Address - Fax:410-864-8051
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412443000Medicaid