Provider Demographics
NPI:1770288102
Name:OLADEJO, MARYAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:OLADEJO
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 1:3727 GREENBRIAR DR STE 114
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3929
Mailing Address - Country:US
Mailing Address - Phone:281-385-8554
Mailing Address - Fax:
Practice Address - Street 1:3727 GREENBRIAR DR STE 114
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3929
Practice Address - Country:US
Practice Address - Phone:281-385-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113828363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health