Provider Demographics
NPI:1700460649
Name:NYA, GODSGIFT ENEBONG (PMHNP)
Entity Type:Individual
Prefix:DR
First Name:GODSGIFT
Middle Name:ENEBONG
Last Name:NYA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 MARITIME CIR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-6099
Mailing Address - Country:US
Mailing Address - Phone:443-600-4202
Mailing Address - Fax:
Practice Address - Street 1:1203 MARITIME CIR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-6099
Practice Address - Country:US
Practice Address - Phone:443-600-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200782363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health