Provider Demographics
NPI:1639711666
Name:FANIYI, OLUWAFEYISINA
Entity Type:Individual
Prefix:MR
First Name:OLUWAFEYISINA
Middle Name:
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 1:5511 DUCHAINE DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4117
Mailing Address - Country:US
Mailing Address - Phone:240-367-2730
Mailing Address - Fax:
Practice Address - Street 1:1130 VARNEY ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4372
Practice Address - Country:US
Practice Address - Phone:202-450-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50082121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker