Provider Demographics
NPI:1750795407
Name:FAMILONI, DAMILOLA KEMISOLA (ND, LAC, MS(NUTRI)
Entity type:Individual
Prefix:DR
First Name:DAMILOLA
Middle Name:KEMISOLA
Last Name:FAMILONI
Suffix:
Gender:F
Credentials:ND, LAC, MS(NUTRI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 WINSTON CHURCHILL CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4849
Mailing Address - Country:US
Mailing Address - Phone:301-237-7125
Mailing Address - Fax:
Practice Address - Street 1:10801 WINSTON CHURCHILL CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4849
Practice Address - Country:US
Practice Address - Phone:301-237-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 174H00000X, 175L00000X
MDU02164171100000X
DCAC500199171100000X
DCNP-0051175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No171100000XOther Service ProvidersAcupuncturist
No174H00000XOther Service ProvidersHealth Educator
No175L00000XOther Service ProvidersHomeopath