Provider Demographics
NPI:1003646787
Name:SHODUNOLA, CAROLINE ODIOR
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ODIOR
Last Name:SHODUNOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 ANITA ST # 595A
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2934
Mailing Address - Country:US
Mailing Address - Phone:773-475-1210
Mailing Address - Fax:
Practice Address - Street 1:595 ANITA ST # 595A
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2934
Practice Address - Country:US
Practice Address - Phone:773-475-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2024060378363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health