Provider Demographics
NPI:1528731213
Name:ASHIRU, SEGUN
Entity type:Individual
Prefix:
First Name:SEGUN
Middle Name:
Last Name:ASHIRU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 NEW YORK AVE NE STE 222
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1851
Mailing Address - Country:US
Mailing Address - Phone:202-516-5737
Mailing Address - Fax:
Practice Address - Street 1:20713 CRYSTAL HILL CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-3935
Practice Address - Country:US
Practice Address - Phone:301-383-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 171M00000X
CNA20212708376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No376K00000XNursing Service Related ProvidersNurse's Aide