Healthcare Provider Details

I. General information

NPI: 1144931056
Provider Name (Legal Business Name): OYINDAMOLA SANNI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 11/19/2023
Certification Date: 11/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 QUINCY ST
BLADENSBURG MD
20710-2330
US

IV. Provider business mailing address

5200 QUINCY ST APT 308
BLADENSBURG MD
20710-2352
US

V. Phone/Fax

Practice location:
  • Phone: 240-960-9869
  • Fax:
Mailing address:
  • Phone: 248-436-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200003182
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: