Provider Demographics
NPI:1780349449
Name:SHONIBARE, SHEFIU
Entity type:Individual
Prefix:
First Name:SHEFIU
Middle Name:
Last Name:SHONIBARE
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 1:15015 CANYON PARK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1555
Mailing Address - Country:US
Mailing Address - Phone:612-222-0410
Mailing Address - Fax:
Practice Address - Street 1:15015 CANYON PARK VIEW DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1555
Practice Address - Country:US
Practice Address - Phone:612-222-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40598162343900000X
343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)