Provider Demographics
NPI:1912719857
Name:OGUNBIYI, RASHEEDAH BIMBO
Entity type:Individual
Prefix:
First Name:RASHEEDAH
Middle Name:BIMBO
Last Name:OGUNBIYI
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 1:9722 GROFFS MILL DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6341
Mailing Address - Country:US
Mailing Address - Phone:443-722-7136
Mailing Address - Fax:
Practice Address - Street 1:2333 BALTIMORE BLVD STE A
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1751
Practice Address - Country:US
Practice Address - Phone:410-900-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR234513363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty