Provider Demographics
NPI:1740764406
Name:TIJANI, SEFIYAT OLAIDE
Entity Type:Individual
Prefix:
First Name:SEFIYAT
Middle Name:OLAIDE
Last Name:TIJANI
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 1:9218 RUSTLING MANOR LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1829
Mailing Address - Country:US
Mailing Address - Phone:346-773-7627
Mailing Address - Fax:
Practice Address - Street 1:9218 RUSTLING MANOR LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1829
Practice Address - Country:US
Practice Address - Phone:346-773-7627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX909000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse