Provider Demographics
NPI:1295269041
Name:OGUNDIRAN, FOLASHADE H
Entity type:Individual
Prefix:
First Name:FOLASHADE
Middle Name:H
Last Name:OGUNDIRAN
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 1:13303 ADAMS PL APT 102
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2035
Mailing Address - Country:US
Mailing Address - Phone:240-444-9575
Mailing Address - Fax:
Practice Address - Street 1:13303 ADAMS PL APT 102
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2035
Practice Address - Country:US
Practice Address - Phone:240-444-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12541374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide