Provider Demographics
NPI:1568259026
Name:SANUSI, MOTUNRAYO ADIJAT
Entity type:Individual
Prefix:
First Name:MOTUNRAYO
Middle Name:ADIJAT
Last Name:SANUSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 MEADOWGATE CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1203
Mailing Address - Country:US
Mailing Address - Phone:410-588-9143
Mailing Address - Fax:
Practice Address - Street 1:1912 MEADOWGATE CT
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1203
Practice Address - Country:US
Practice Address - Phone:410-588-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190157363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health