Provider Demographics
NPI:1699240036
Name:ONIFADE, MODUPE S
Entity type:Individual
Prefix:
First Name:MODUPE
Middle Name:S
Last Name:ONIFADE
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 1:849 21ST ST NE APT 7
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4166
Mailing Address - Country:US
Mailing Address - Phone:240-556-8334
Mailing Address - Fax:
Practice Address - Street 1:849 21ST ST NE APT 7
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4166
Practice Address - Country:US
Practice Address - Phone:240-556-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13947374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide