Provider Demographics
NPI:1780117994
Name:GADAGBUI, SEYRA
Entity type:Individual
Prefix:MR
First Name:SEYRA
Middle Name:
Last Name:GADAGBUI
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 1:2057 MEDICAL ROW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051
Mailing Address - Country:US
Mailing Address - Phone:214-887-1626
Mailing Address - Fax:214-594-8797
Practice Address - Street 1:2507 MEDICAL ROW
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1070
Practice Address - Country:US
Practice Address - Phone:214-887-1626
Practice Address - Fax:214-594-8797
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic