Provider Demographics
NPI:1871947812
Name:ZACCHEUS, OLUSOLA (MAT, EDS)
Entity type:Individual
Prefix:MS
First Name:OLUSOLA
Middle Name:
Last Name:ZACCHEUS
Suffix:
Gender:F
Credentials:MAT, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 56TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6744
Mailing Address - Country:US
Mailing Address - Phone:201-281-4458
Mailing Address - Fax:
Practice Address - Street 1:269 56TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6744
Practice Address - Country:US
Practice Address - Phone:201-281-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist