Provider Demographics
NPI:1427413053
Name:FALADE, OLUWAKEMI ADEFILA
Entity type:Individual
Prefix:
First Name:OLUWAKEMI
Middle Name:ADEFILA
Last Name:FALADE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 OGLETHORPE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1540
Mailing Address - Country:US
Mailing Address - Phone:240-779-6180
Mailing Address - Fax:
Practice Address - Street 1:4213 OGLETHORPE ST APT 4
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1540
Practice Address - Country:US
Practice Address - Phone:240-779-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-26
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11568374U00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374U00000XNursing Service Related ProvidersHome Health Aide