Provider Demographics
NPI:1093178568
Name:OLABISI, JENDAYI (MD)
Entity Type:Individual
Prefix:MS
First Name:JENDAYI
Middle Name:
Last Name:OLABISI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 E 86TH ST STE 65E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1831
Mailing Address - Country:US
Mailing Address - Phone:317-572-5242
Mailing Address - Fax:
Practice Address - Street 1:1060 E 86TH ST STE 65E
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1831
Practice Address - Country:US
Practice Address - Phone:173-572-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01081065A2084P0800X
390200000X
FLME1500172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11019012AOtherIN TEMPORARY MEDICAL LICENSE