Provider Demographics
NPI:1497508063
Name:APANPA, OLU I (DIETITIAN)
Entity Type:Individual
Prefix:MR
First Name:OLU
Middle Name:I
Last Name:APANPA
Suffix:
Gender:M
Credentials:DIETITIAN
Other - Prefix:MR
Other - First Name:OLU
Other - Middle Name:I
Other - Last Name:APANPA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED DIETITIAN
Mailing Address - Street 1:15515 N CONDUIT AVE APT 6M
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4342
Mailing Address - Country:US
Mailing Address - Phone:917-651-3684
Mailing Address - Fax:
Practice Address - Street 1:15515 JAMAICA AVE # 11434
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3829
Practice Address - Country:US
Practice Address - Phone:917-651-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005894133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty