Healthcare Provider Details

I. General information

NPI: 1194462648
Provider Name (Legal Business Name): MICHAEL DEJI SANYA APN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 MORRIS AVE STE 107
UNION NJ
07083-4841
US

IV. Provider business mailing address

2810 MORRIS AVE STE 107
UNION NJ
07083-4841
US

V. Phone/Fax

Practice location:
  • Phone: 305-842-2185
  • Fax: 973-834-5399
Mailing address:
  • Phone: 305-842-2185
  • Fax: 973-834-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01303800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: