Provider Demographics
NPI:1912443789
Name:OYEKOYA, WALE
Entity Type:Individual
Prefix:
First Name:WALE
Middle Name:
Last Name:OYEKOYA
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 1:5805 LAWTON CT
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MARYLAND
Mailing Address - Zip Code:20706
Mailing Address - Country:UM
Mailing Address - Phone:240-217-1665
Mailing Address - Fax:
Practice Address - Street 1:5805 LAWTON CT
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MARYLAND
Practice Address - Zip Code:20706
Practice Address - Country:UM
Practice Address - Phone:240-217-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities