Provider Demographics
NPI:1780365650
Name:AKUNWAFOR, CYRIL
Entity type:Individual
Prefix:
First Name:CYRIL
Middle Name:
Last Name:AKUNWAFOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:OKECHUKWU
Other - Middle Name:CYRIL
Other - Last Name:AKUNWAFOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3511 ETON DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6800
Mailing Address - Country:US
Mailing Address - Phone:301-442-8846
Mailing Address - Fax:
Practice Address - Street 1:3511 ETON DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6800
Practice Address - Country:US
Practice Address - Phone:301-442-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR216269363LP0808X
DCRN1038274163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse