Provider Demographics
NPI:1457582074
Name:FASHANU, ABIOLA VICTORIA
Entity type:Individual
Prefix:
First Name:ABIOLA
Middle Name:VICTORIA
Last Name:FASHANU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABIOLA
Other - Middle Name:YETUNDE
Other - Last Name:FASHANU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:736 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-4421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:736 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58122-4421
Practice Address - Country:US
Practice Address - Phone:612-345-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT194377207R00000X
ND13272207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine