Healthcare Provider Details

I. General information

NPI: 1205156395
Provider Name (Legal Business Name): HUMU SANUSI AFONJA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169-33 144 ROAD SWEET P. HOME CARE INC.
SPRINGFIELD GARDENS NY
11434
US

IV. Provider business mailing address

169-33 144 ROAD SWEET P. HOME CARE INC.
SPRINGFIELD GARDENS NY
11434
US

V. Phone/Fax

Practice location:
  • Phone: 718-978-7221
  • Fax: 718-978-0032
Mailing address:
  • Phone: 718-978-7221
  • Fax: 718-978-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number294040-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: