Basic Information
| Provider Information | |||||||||
| NPI: | 1710157961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANIMASHAUN | ||||||||
| FirstName: | YAHAYA | ||||||||
| MiddleName: | AKOLADE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1511 OAKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070835426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082478768 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1511 OAKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070835426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082478768 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2008 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26NO10656800 | NJ | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 26NJO1182500 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 26NJO1182500 | 01 | NJ | PROFESSIONAL LICENSE NUMBER | OTHER |