Provider Demographics
NPI:1255131603
Name:SANNI, TEMITAYO
Entity type:Individual
Prefix:
First Name:TEMITAYO
Middle Name:
Last Name:SANNI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 QUINCY ST APT 308
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2352
Mailing Address - Country:US
Mailing Address - Phone:240-960-9869
Mailing Address - Fax:
Practice Address - Street 1:5200 QUINCY ST APT 308
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2352
Practice Address - Country:US
Practice Address - Phone:240-960-9869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200004561374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide