Provider Demographics
NPI:1740386143
Name:SANYIKA, MWAWAZA MFIKIRI (MD)
Entity Type:Individual
Prefix:DR
First Name:MWAWAZA
Middle Name:MFIKIRI
Last Name:SANYIKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E TOWN ST STE 228
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4741
Mailing Address - Country:US
Mailing Address - Phone:614-418-7771
Mailing Address - Fax:614-241-5595
Practice Address - Street 1:393 E TOWN ST STE 228
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4741
Practice Address - Country:US
Practice Address - Phone:614-418-7771
Practice Address - Fax:614-241-5595
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TA0400X
OH35081282207Q00000X
OH0228397502083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000249250OtherANTHEM PROVIDER NUMBER
OH36D1003074OtherCLIA NUMBER
OH2333942Medicaid
OHSA4088091Medicare PIN
OH36D1003074OtherCLIA NUMBER