Provider Demographics
NPI:1285420935
Name:AJALA, OLUDOYIN O (MSN, APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:OLUDOYIN
Middle Name:O
Last Name:AJALA
Suffix:
Gender:
Credentials:MSN, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10398 STONE PINE AVE
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5796
Mailing Address - Country:US
Mailing Address - Phone:202-834-4048
Mailing Address - Fax:
Practice Address - Street 1:173 SAINT PATRICKS DR STE 104
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5530
Practice Address - Country:US
Practice Address - Phone:202-834-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024193291363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health