Provider Demographics
NPI:1225741697
Name:MESIOYE, OLUMIDE OLALEKAN
Entity type:Individual
Prefix:
First Name:OLUMIDE
Middle Name:OLALEKAN
Last Name:MESIOYE
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 1:3 SHEPHERD WAY
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5178
Mailing Address - Country:US
Mailing Address - Phone:240-997-0287
Mailing Address - Fax:
Practice Address - Street 1:3 SHEPHERD WAY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5178
Practice Address - Country:US
Practice Address - Phone:240-997-0287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175696363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health