Healthcare Provider Details

I. General information

NPI: 1962907576
Provider Name (Legal Business Name): MS. ADURAGBEMI JULIANA AYENI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MEDICAL PLAZA DR STE 330
SHENANDOAH TX
77380-3271
US

IV. Provider business mailing address

1840 WOODLAND FIELD XING APT 127
SPRING TX
77380-4398
US

V. Phone/Fax

Practice location:
  • Phone: 832-663-0037
  • Fax: 281-962-3033
Mailing address:
  • Phone: 404-729-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberW6431
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberW6431
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: