Provider Demographics
NPI:1801358551
Name:AJAYI, OLAIDE OLUWATOMI (NP)
Entity Type:Individual
Prefix:
First Name:OLAIDE
Middle Name:OLUWATOMI
Last Name:AJAYI
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 1:3221 MOSSY BEND LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-2558
Mailing Address - Country:US
Mailing Address - Phone:832-407-4732
Mailing Address - Fax:
Practice Address - Street 1:11914 ASTORIA BLVD STE 280
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6047
Practice Address - Country:US
Practice Address - Phone:713-486-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner