Provider Demographics
NPI:1609360411
Name:FAFUNMI, TAIWO TUNDE
Entity Type:Individual
Prefix:
First Name:TAIWO
Middle Name:TUNDE
Last Name:FAFUNMI
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 1:9105 STACY LYNN LN
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8485
Mailing Address - Country:US
Mailing Address - Phone:405-835-9181
Mailing Address - Fax:
Practice Address - Street 1:9105 STACY LYNN LN
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8485
Practice Address - Country:US
Practice Address - Phone:405-835-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician