Provider Demographics
NPI:1689250193
Name:SHITTU, FAUSAT
Entity Type:Individual
Prefix:
First Name:FAUSAT
Middle Name:
Last Name:SHITTU
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 1:3011 ZEPHYR GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7282
Mailing Address - Country:US
Mailing Address - Phone:713-377-1497
Mailing Address - Fax:
Practice Address - Street 1:3011 ZEPHYR GLEN WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7282
Practice Address - Country:US
Practice Address - Phone:713-377-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNON