Provider Demographics
NPI:1962969758
Name:OSUNLUSI, AYODELE JOHN
Entity type:Individual
Prefix:
First Name:AYODELE
Middle Name:JOHN
Last Name:OSUNLUSI
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 1:3400 DODGE PARK RD APT 201
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2001
Mailing Address - Country:US
Mailing Address - Phone:301-323-3383
Mailing Address - Fax:
Practice Address - Street 1:3400 DODGE PARK RD APT 201
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2001
Practice Address - Country:US
Practice Address - Phone:301-323-3383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant