Provider Demographics
NPI:1598565723
Name:OYEFESO, FUNLOLA
Entity type:Individual
Prefix:
First Name:FUNLOLA
Middle Name:
Last Name:OYEFESO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9153 RIVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1781
Mailing Address - Country:US
Mailing Address - Phone:469-412-0574
Mailing Address - Fax:
Practice Address - Street 1:9153 RIVER HILL RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1781
Practice Address - Country:US
Practice Address - Phone:469-412-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide