Provider Demographics
NPI:1881357317
Name:SHOTE, OLASUNKAMI
Entity type:Individual
Prefix:
First Name:OLASUNKAMI
Middle Name:
Last Name:SHOTE
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 1:2906 SAW PALMETTO TRL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3738
Mailing Address - Country:US
Mailing Address - Phone:832-727-6748
Mailing Address - Fax:
Practice Address - Street 1:2906 SAW PALMETTO TRL
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3738
Practice Address - Country:US
Practice Address - Phone:832-727-6748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor