Provider Demographics
NPI:1689272619
Name:SAGAY, DUDUYEMI
Entity Type:Individual
Prefix:MISS
First Name:DUDUYEMI
Middle Name:
Last Name:SAGAY
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 1:2747 E CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2308
Mailing Address - Country:US
Mailing Address - Phone:347-603-5168
Mailing Address - Fax:
Practice Address - Street 1:2747 E CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2308
Practice Address - Country:US
Practice Address - Phone:347-603-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9509521253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ9509521OtherDCS