Provider Demographics
NPI:1972650885
Name:SHEKONI, ADESOLA F (MD)
Entity Type:Individual
Prefix:DR
First Name:ADESOLA
Middle Name:F
Last Name:SHEKONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADESOLA
Other - Middle Name:F
Other - Last Name:SHEKONI-DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:NORTH JACKSON MEDICAL CLINIC PO BOX 4522
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296
Mailing Address - Country:US
Mailing Address - Phone:601-713-0890
Mailing Address - Fax:601-366-3415
Practice Address - Street 1:5160 GALAXIE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206
Practice Address - Country:US
Practice Address - Phone:601-713-0890
Practice Address - Fax:601-366-3415
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117502Medicaid
MS00117502Medicaid
MS110001218Medicare PIN