Provider Demographics
NPI:1477340909
Name:AKEREDOLU, OLUMIDE STEPHEN (CAA)
Entity type:Individual
Prefix:
First Name:OLUMIDE
Middle Name:STEPHEN
Last Name:AKEREDOLU
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:OLUMIDE
Other - Middle Name:STEPHEN
Other - Last Name:BAMIYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAA
Mailing Address - Street 1:26923 LONGWOOD LEDGE LN
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1924
Mailing Address - Country:US
Mailing Address - Phone:912-480-7550
Mailing Address - Fax:
Practice Address - Street 1:865 DESHONG DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9313
Practice Address - Country:US
Practice Address - Phone:903-737-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant