Provider Demographics
NPI:1639588767
Name:OLUNKWA, GODDY SUNNY (MHA)
Entity Type:Individual
Prefix:
First Name:GODDY
Middle Name:SUNNY
Last Name:OLUNKWA
Suffix:
Gender:M
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SKYLINE ROAD
Mailing Address - Street 2:SUITE 1011
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-2371
Mailing Address - Country:US
Mailing Address - Phone:972-704-5224
Mailing Address - Fax:214-444-7152
Practice Address - Street 1:1350 SKYLINE RD
Practice Address - Street 2:SUITE 1011
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-2377
Practice Address - Country:US
Practice Address - Phone:972-704-5224
Practice Address - Fax:214-444-7152
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage