Provider Demographics
NPI:1285466177
Name:OSIFADE, OLUFELA
Entity type:Individual
Prefix:
First Name:OLUFELA
Middle Name:
Last Name:OSIFADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 HAMPTON FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7223
Mailing Address - Country:US
Mailing Address - Phone:240-593-6426
Mailing Address - Fax:
Practice Address - Street 1:5609 HAMPTON FOREST WAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7223
Practice Address - Country:US
Practice Address - Phone:240-593-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program