Provider Demographics
NPI:1841788619
Name:SHADA, TOLULOPE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:
Last Name:SHADA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EXECUTIVE CENTER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1136
Mailing Address - Country:US
Mailing Address - Phone:915-910-4661
Mailing Address - Fax:915-545-6634
Practice Address - Street 1:100 EXECUTIVE CENTER BLVD STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1136
Practice Address - Country:US
Practice Address - Phone:915-910-4661
Practice Address - Fax:915-975-5893
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP200731022084P0804X
390200000X
NMMD2023-10452084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program