Provider Demographics
NPI:1598575524
Name:OLUYEDE, OLUBUNMI
Entity type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:
Last Name:OLUYEDE
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 1:5111 JUMPROCK CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4201
Mailing Address - Country:US
Mailing Address - Phone:301-710-7081
Mailing Address - Fax:
Practice Address - Street 1:5111 JUMPROCK CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4201
Practice Address - Country:US
Practice Address - Phone:301-710-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181379363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health