Provider Demographics
NPI:1083277719
Name:SHOYOMI, OLUWAFUNMILAYO LINDA
Entity Type:Individual
Prefix:
First Name:OLUWAFUNMILAYO
Middle Name:LINDA
Last Name:SHOYOMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLUWAFUNMILAYO
Other - Middle Name:LINDA
Other - Last Name:ONIPINSAIYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 820,
Mailing Address - Street 2:BUSINESS TOWER 1, SUITE 200,
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:9842 AUDELIA RD APT 1093
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-1967
Practice Address - Country:US
Practice Address - Phone:214-434-6827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2145602225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant