Provider Demographics
NPI:1609416296
Name:ADEBAYO, ADEOLA SERIFAT
Entity Type:Individual
Prefix:
First Name:ADEOLA
Middle Name:SERIFAT
Last Name:ADEBAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 SUNCREEK LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3194
Mailing Address - Country:US
Mailing Address - Phone:832-724-7929
Mailing Address - Fax:
Practice Address - Street 1:3227 MEADE AVE STE 5B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7810
Practice Address - Country:US
Practice Address - Phone:725-333-2411
Practice Address - Fax:702-952-5257
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144448363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty