Provider Demographics
NPI:1376976357
Name:SANNI, WASIU OLAWALE
Entity Type:Individual
Prefix:
First Name:WASIU
Middle Name:OLAWALE
Last Name:SANNI
Suffix:
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 1:1205 E 49TH ST # B1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1512
Mailing Address - Country:US
Mailing Address - Phone:347-842-7607
Mailing Address - Fax:
Practice Address - Street 1:1205 E 49TH ST # B1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1512
Practice Address - Country:US
Practice Address - Phone:347-842-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315128164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse