Healthcare Provider Details

I. General information

NPI: 1891650776
Provider Name (Legal Business Name): NANA LUTHER ADABANKAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 WALTON AVE APT 4D
BRONX NY
10452-6152
US

IV. Provider business mailing address

1563 WALTON AVE APT 4D
BRONX NY
10452-6152
US

V. Phone/Fax

Practice location:
  • Phone: 646-353-7498
  • Fax:
Mailing address:
  • Phone: 646-353-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF406559-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: