Provider Demographics
NPI:1467063149
Name:FANIYI, OLUYINIKA YOMI
Entity Type:Individual
Prefix:
First Name:OLUYINIKA
Middle Name:YOMI
Last Name:FANIYI
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 1:14912 WHITTIER LOOP
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5724
Mailing Address - Country:US
Mailing Address - Phone:571-277-4451
Mailing Address - Fax:
Practice Address - Street 1:3005 BLADENSBURG RD NE APT 417
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2241
Practice Address - Country:US
Practice Address - Phone:202-581-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant