Provider Demographics
NPI:1417705641
Name:AKOSILE, AMINAT FUNKE
Entity type:Individual
Prefix:
First Name:AMINAT
Middle Name:FUNKE
Last Name:AKOSILE
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 1:3405 CROYDON RD
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4546
Mailing Address - Country:US
Mailing Address - Phone:443-635-4456
Mailing Address - Fax:
Practice Address - Street 1:3405 CROYDON RD
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-4546
Practice Address - Country:US
Practice Address - Phone:443-635-4456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-02260374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide