Provider Demographics
NPI:1871300053
Name:FAYESE, OLUWATOYIN TITILAYO
Entity type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:TITILAYO
Last Name:FAYESE
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 1:16329 PENNSBURY WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1768
Mailing Address - Country:US
Mailing Address - Phone:862-291-1769
Mailing Address - Fax:
Practice Address - Street 1:16329 PENNSBURY WAY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1768
Practice Address - Country:US
Practice Address - Phone:862-291-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide