Provider Demographics
NPI:1285015420
Name:FEYISETAN, SAIB
Entity Type:Individual
Prefix:
First Name:SAIB
Middle Name:
Last Name:FEYISETAN
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 1:2304 OAK LN
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8812
Mailing Address - Country:US
Mailing Address - Phone:214-909-7399
Mailing Address - Fax:
Practice Address - Street 1:2304 OAK LN
Practice Address - Street 2:SUITE 5
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8812
Practice Address - Country:US
Practice Address - Phone:214-909-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)