MEDICARE: OLAKUNLE SUNDAY FASAN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1215332	TX

General Provider Information

NPI Number	:	1386510956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLAKUNLE SUNDAY FASAN

Provider Business Mailing Address
First Line	:	29142 HAUTER WAY
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-2317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 BALCONES DR STE 8370
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4257
Country	:	US
Telephone Number	:	713-260-2100
Fax Number	:	804-207-8849

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

Provider Enumeration Date	:	10/13/2025
Last Update Date	:	12/12/2025

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