Provider Demographics
NPI:1619445368
Name:SOFAYO, COMFORT BOSEDE (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:COMFORT
Middle Name:BOSEDE
Last Name:SOFAYO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:COMFORT
Other - Middle Name:BOSEDE
Other - Last Name:ADEBOJE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2506 KINGSTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-6606
Mailing Address - Country:US
Mailing Address - Phone:773-964-5325
Mailing Address - Fax:
Practice Address - Street 1:2506 KINGSTON ST
Practice Address - Street 2:APT 2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019
Practice Address - Country:US
Practice Address - Phone:773-964-5325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily