Provider Demographics
NPI:1871233064
Name:FASANYA, HENRIETTA OYEYEMI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HENRIETTA
Middle Name:OYEYEMI
Last Name:FASANYA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:HENRIETTA
Other - Middle Name:OYEYEMI
Other - Last Name:MAKU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:6565 FANNIN ST STE M227
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6565 FANNIN ST STE M227
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program