Provider Demographics
NPI:1528499837
Name:OKORODUDU, STELLA
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:OKORODUDU
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 1:271 RED CLAY RD
Mailing Address - Street 2:APT 301
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2323
Mailing Address - Country:US
Mailing Address - Phone:301-503-0360
Mailing Address - Fax:
Practice Address - Street 1:6120 KANSAS AVENUE
Practice Address - Street 2:
Practice Address - City:NORTHWEST
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-722-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9895251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health