Provider Demographics
NPI:1447560941
Name:SHOROYE, OLUSEGUN ABIODUN (BA)
Entity Type:Individual
Prefix:MR
First Name:OLUSEGUN
Middle Name:ABIODUN
Last Name:SHOROYE
Suffix:
Gender:M
Credentials:BA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2615 W GARY AVE UNIT 1060
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-6489
Mailing Address - Country:US
Mailing Address - Phone:702-487-6074
Mailing Address - Fax:
Practice Address - Street 1:3450 W CHEYENNE AVE STE 500
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8225
Practice Address - Country:US
Practice Address - Phone:702-631-0230
Practice Address - Fax:702-631-0809
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst