Provider Demographics
NPI:1194462648
Name:SANYA, MICHAEL DEJI (APN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEJI
Last Name:SANYA
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CENTRAL AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2838
Mailing Address - Country:US
Mailing Address - Phone:862-658-7190
Mailing Address - Fax:
Practice Address - Street 1:310 CENTRAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2838
Practice Address - Country:US
Practice Address - Phone:862-658-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01303800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health