Provider Demographics
NPI:1639780406
Name:ADEDAPO, ABOSEDE COMFORT (NP)
Entity Type:Individual
Prefix:MRS
First Name:ABOSEDE
Middle Name:COMFORT
Last Name:ADEDAPO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 RED CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6965
Mailing Address - Country:US
Mailing Address - Phone:904-962-0533
Mailing Address - Fax:
Practice Address - Street 1:12805 CULLEN BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-3759
Practice Address - Country:US
Practice Address - Phone:832-370-6513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1005212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily