Provider Demographics
NPI:1689440547
Name:SANOU-ADEKANMBI, DAMMY
Entity Type:Individual
Prefix:
First Name:DAMMY
Middle Name:
Last Name:SANOU-ADEKANMBI
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 1:7101 SELLERS AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2023
Mailing Address - Country:US
Mailing Address - Phone:215-869-5597
Mailing Address - Fax:
Practice Address - Street 1:7101 SELLERS AVE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2023
Practice Address - Country:US
Practice Address - Phone:215-869-5597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010537363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health