Provider Demographics
NPI:1013626829
Name:SOWUNMI, TAIWO
Entity Type:Individual
Prefix:
First Name:TAIWO
Middle Name:
Last Name:SOWUNMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10293 KINGS GAP WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-9832
Mailing Address - Country:US
Mailing Address - Phone:317-258-7119
Mailing Address - Fax:
Practice Address - Street 1:OPTIONS BEHAVIORAL HEALTH SERVICES
Practice Address - Street 2:5602 CAITO DRIVE
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-4622
Practice Address - Country:US
Practice Address - Phone:317-300-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7101328A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health