Provider Demographics
NPI:1073208351
Name:OMISANMI, AKINTUNDE GANIYU SR
Entity Type:Individual
Prefix:
First Name:AKINTUNDE
Middle Name:GANIYU
Last Name:OMISANMI
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 ALABASTER CT
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1872
Mailing Address - Country:US
Mailing Address - Phone:240-353-2171
Mailing Address - Fax:202-750-7383
Practice Address - Street 1:915 RHODE ISLAND AVENUE, SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001
Practice Address - Country:US
Practice Address - Phone:301-232-6100
Practice Address - Fax:202-750-7383
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker