Healthcare Provider Details

I. General information

NPI: 1215399787
Provider Name (Legal Business Name): AYODEJI AJAO SANUSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST FL 6
DOVER DE
19901-3530
US

IV. Provider business mailing address

640 S STATE ST # MC3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-6220
  • Fax: 302-734-8454
Mailing address:
  • Phone: 302-744-6220
  • Fax: 302-734-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberC1-0029146
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: