Provider Demographics
NPI:1891591509
Name:FUNMILAYO, DAMILOLA
Entity type:Individual
Prefix:
First Name:DAMILOLA
Middle Name:
Last Name:FUNMILAYO
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 1:725 HERNDON WOODS CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5137
Mailing Address - Country:US
Mailing Address - Phone:202-681-1255
Mailing Address - Fax:
Practice Address - Street 1:725 HERNDON WOODS CT
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5137
Practice Address - Country:US
Practice Address - Phone:202-681-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program