Provider Demographics
NPI:1215576541
Name:YESSUFF, OLUWAGBENRO DAVID
Entity Type:Individual
Prefix:
First Name:OLUWAGBENRO
Middle Name:DAVID
Last Name:YESSUFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 NIGHTINGALE DR
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-3585
Mailing Address - Country:US
Mailing Address - Phone:972-322-8793
Mailing Address - Fax:
Practice Address - Street 1:1516 NIGHTINGALE DR
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-3585
Practice Address - Country:US
Practice Address - Phone:972-322-8793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician