Provider Demographics
NPI:1407318553
Name:FASHUSI, OLUSEYI O (PA-C)
Entity Type:Individual
Prefix:
First Name:OLUSEYI
Middle Name:O
Last Name:FASHUSI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2025 SLOAN PL STE 35
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2092
Mailing Address - Country:US
Mailing Address - Phone:651-772-1572
Mailing Address - Fax:651-772-1889
Practice Address - Street 1:8325 CITY CENTRE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3323
Practice Address - Country:US
Practice Address - Phone:651-731-0859
Practice Address - Fax:651-731-0976
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2020-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN13225363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant