Provider Demographics
NPI:1871208371
Name:AKINFENWA, OLATUNDE
Entity type:Individual
Prefix:MR
First Name:OLATUNDE
Middle Name:
Last Name:AKINFENWA
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 1:408 VALLEY MEADOW CIR APT A1
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1536
Mailing Address - Country:US
Mailing Address - Phone:443-922-5455
Mailing Address - Fax:
Practice Address - Street 1:408 VALLEY MEADOW CIR APT A1
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1536
Practice Address - Country:US
Practice Address - Phone:443-922-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician