1447560941 NPI number — MR. OLUSEGUN ABIODUN SHOROYE BA

Table of content: MR. OLUSEGUN ABIODUN SHOROYE BA (NPI 1447560941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447560941 NPI number — MR. OLUSEGUN ABIODUN SHOROYE BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOROYE
Provider First Name:
OLUSEGUN
Provider Middle Name:
ABIODUN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447560941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2615 W GARY AVE UNIT 1060
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89123-6489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-487-6074
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 W CHEYENNE AVE STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89032-8225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-631-0230
Provider Business Practice Location Address Fax Number:
702-631-0809
Provider Enumeration Date:
10/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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