Provider Demographics
NPI:1427313980
Name:OLADUNJOYE-PHILLIPS, OLUWASEYI A (PMHNP)
Entity type:Individual
Prefix:
First Name:OLUWASEYI
Middle Name:A
Last Name:OLADUNJOYE-PHILLIPS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:OLUWASEYI
Other - Middle Name:A
Other - Last Name:OLA-PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGSW, NP
Mailing Address - Street 1:126 PHILOSOPHERS TER
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1715
Mailing Address - Country:US
Mailing Address - Phone:443-215-5353
Mailing Address - Fax:833-615-2165
Practice Address - Street 1:126 PHILOSOPHERS TER
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1715
Practice Address - Country:US
Practice Address - Phone:443-215-5353
Practice Address - Fax:833-615-2165
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD196772163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse