Provider Demographics
NPI:1407102353
Name:SHITTU, BASIRAT OLABISI
Entity type:Individual
Prefix:
First Name:BASIRAT
Middle Name:OLABISI
Last Name:SHITTU
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 1:5921 CHERRYWOOD TER
Mailing Address - Street 2:APT 301
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3146
Mailing Address - Country:US
Mailing Address - Phone:240-487-8564
Mailing Address - Fax:
Practice Address - Street 1:5921 CHERRYWOOD TER
Practice Address - Street 2:APT 301
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3146
Practice Address - Country:US
Practice Address - Phone:240-487-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide