Provider Demographics
NPI:1124335971
Name:ODUKOYA, OLUFEMI
Entity type:Individual
Prefix:MR
First Name:OLUFEMI
Middle Name:
Last Name:ODUKOYA
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 1:6400 OLD CHAPEL TER
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4609
Mailing Address - Country:US
Mailing Address - Phone:301-583-0001
Mailing Address - Fax:
Practice Address - Street 1:6400 OLD CHAPEL TER
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4609
Practice Address - Country:US
Practice Address - Phone:301-583-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16030104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker