Provider Demographics
NPI:1013580240
Name:SALAKO, ADEBOWALE SHADRACH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:ADEBOWALE
Middle Name:SHADRACH
Last Name:SALAKO
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 HIGHWAY 6 N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2302
Mailing Address - Country:US
Mailing Address - Phone:281-859-3210
Mailing Address - Fax:
Practice Address - Street 1:9101 HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2302
Practice Address - Country:US
Practice Address - Phone:281-859-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX853775163W00000X
TX1060750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1013580240Medicaid