Provider Demographics
NPI:1336805084
Name:AFOLABI-ZANNU, RISIKAT A
Entity Type:Individual
Prefix:MRS
First Name:RISIKAT
Middle Name:A
Last Name:AFOLABI-ZANNU
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 1:7608 GEORGIAN DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4496
Mailing Address - Country:US
Mailing Address - Phone:240-449-9174
Mailing Address - Fax:
Practice Address - Street 1:7608 GEORGIAN DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4496
Practice Address - Country:US
Practice Address - Phone:240-449-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR116607363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health