MEDICARE: SHAKIRAT OLAIDE ADESHOKAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	225809	TX

General Provider Information

NPI Number	:	1104446293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAKIRAT OLAIDE ADESHOKAN

Provider Business Mailing Address
First Line	:	1506 WHITE WILLOW LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1506 WHITE WILLOW LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4624
Country	:	US
Telephone Number	:	972-464-8355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2020
Last Update Date	:	04/20/2020

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Directions to “ SHAKIRAT OLAIDE ADESHOKAN ” Practice Location

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