Provider Demographics
NPI:1669863742
Name:SANNI, OLAMIDE GANIYAT (NURSE)
Entity type:Individual
Prefix:MS
First Name:OLAMIDE
Middle Name:GANIYAT
Last Name:SANNI
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 DUMONT AVE APT 5E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-5451
Mailing Address - Country:US
Mailing Address - Phone:347-659-7723
Mailing Address - Fax:
Practice Address - Street 1:710 DUMONT AVE APT 5E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5451
Practice Address - Country:US
Practice Address - Phone:347-659-7723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319894-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse