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General NPI Number Information
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NPI Number | 1518845429
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Entity Type | Individual
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Provider Name | JESSICA ADEBISI BANJI-AJALA
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Gender | Female
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1919 FULLER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2626
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Country | US
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Telephone | 215-439-8717
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E LEHIGH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19125-1012
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Country | US
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Telephone | 215-439-8717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP033655
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License Number State | PA
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