Provider Demographics
NPI:1689374019
Name:OBISANYA, ISLAMIYAT TOYIN
Entity Type:Individual
Prefix:
First Name:ISLAMIYAT
Middle Name:TOYIN
Last Name:OBISANYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 LOG MILL CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1860
Mailing Address - Country:US
Mailing Address - Phone:240-467-6532
Mailing Address - Fax:
Practice Address - Street 1:2553 LOG MILL CT
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1860
Practice Address - Country:US
Practice Address - Phone:240-467-6532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker