Provider Demographics
NPI:1134679392
Name:OLADIPO, AUGUSTA
Entity type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:
Last Name:OLADIPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUGUSTA
Other - Middle Name:
Other - Last Name:AKPABIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18007 BRAZOS RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2167
Mailing Address - Country:US
Mailing Address - Phone:301-875-1904
Mailing Address - Fax:
Practice Address - Street 1:500 UPPER CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4324
Practice Address - Country:US
Practice Address - Phone:443-643-1500
Practice Address - Fax:443-643-1505
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206557363LA2200X
MDAC006598363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health