Provider Demographics
NPI:1619193810
Name:DARAMY, OLABISI AGATHA (MS LD CNS)
Entity type:Individual
Prefix:MRS
First Name:OLABISI
Middle Name:AGATHA
Last Name:DARAMY
Suffix:
Gender:F
Credentials:MS LD CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 504M
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3269
Mailing Address - Country:US
Mailing Address - Phone:301-891-4998
Mailing Address - Fax:301-879-2074
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 504M
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3269
Practice Address - Country:US
Practice Address - Phone:301-891-4998
Practice Address - Fax:301-879-2074
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01243133NN1002X
DCD183133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDZZX1OAOtherCAREFIRST BCBS
DC3927-0001OtherCAREFIRST BCBS