Healthcare Provider Details

I. General information

NPI: 1053676130
Provider Name (Legal Business Name): TITILAYO SANNI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW STE 200
WASHINGTON DC
20011-1141
US

IV. Provider business mailing address

711 56TH PL NE
WASHINGTON DC
20019-7006
US

V. Phone/Fax

Practice location:
  • Phone: 202-525-3954
  • Fax:
Mailing address:
  • Phone: 202-200-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC200001939
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: