Provider Demographics
NPI:1972077295
Name:ODEYALE, RASHIDAT (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:RASHIDAT
Middle Name:
Last Name:ODEYALE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 GAMBRILLS RD UNIT 618
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-7524
Mailing Address - Country:US
Mailing Address - Phone:240-927-0957
Mailing Address - Fax:
Practice Address - Street 1:388 GAMBRILLS RD UNIT 618
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-7524
Practice Address - Country:US
Practice Address - Phone:240-927-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR269551363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health