Provider Demographics
NPI:1770842130
Name:ADEFISAYO, ADERONKE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADERONKE
Middle Name:
Last Name:ADEFISAYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7231 LAGUNA VILLAS
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4394
Mailing Address - Country:US
Mailing Address - Phone:631-346-5387
Mailing Address - Fax:662-627-5440
Practice Address - Street 1:7231 LAGUNA VILLAS
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4394
Practice Address - Country:US
Practice Address - Phone:631-344-5387
Practice Address - Fax:662-627-5440
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26085208000000X
TXT7472208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics