Provider Demographics
NPI:1871914812
Name:OKOYA ODEBIYI, FUNMILAYO
Entity type:Individual
Prefix:MRS
First Name:FUNMILAYO
Middle Name:
Last Name:OKOYA ODEBIYI
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 1:7401 NEW HAMPSHIRE AVE
Mailing Address - Street 2:# 904
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6945
Mailing Address - Country:US
Mailing Address - Phone:240-472-9483
Mailing Address - Fax:
Practice Address - Street 1:7401 NEW HAMPSHIRE AVE
Practice Address - Street 2:# 904
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6945
Practice Address - Country:US
Practice Address - Phone:240-472-9483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA8024374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide