Provider Demographics
NPI:1710157961
Name:ANIMASHAUN, YAHAYA AKOLADE (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:YAHAYA
Middle Name:AKOLADE
Last Name:ANIMASHAUN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ETON DR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2482
Mailing Address - Country:US
Mailing Address - Phone:908-247-8768
Mailing Address - Fax:
Practice Address - Street 1:188 FRIES MILL RD STE E2
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2015
Practice Address - Country:US
Practice Address - Phone:551-214-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10656800163W00000X
NJ26NJO1182500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJO1182500OtherPROFESSIONAL LICENSE NUMBER