MEDICARE: HUMU SANUSI AFONJA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	294040-1	NY

General Provider Information

NPI Number	:	1205156395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUMU SANUSI AFONJA

Provider Business Mailing Address
First Line	:	169-33 144 ROAD
Second Line	:	SWEET P. HOME CARE INC.
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11434
Country	:	US
Telephone Number	:	718-978-7221
Fax Number	:	718-978-0032

Provider Business Practice Location Address
First Line	:	169-33 144 ROAD
Second Line	:	SWEET P. HOME CARE INC.
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11434
Country	:	US
Telephone Number	:	718-978-7221
Fax Number	:	718-978-0032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2010
Last Update Date	:	09/08/2010

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