Healthcare Provider Details

I. General information

NPI: 1801602628
Provider Name (Legal Business Name): OLUWADARASIMI SOLIAT SEKUMADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9905 FALL CREEK RD
INDIANAPOLIS IN
46256-4804
US

IV. Provider business mailing address

4918 WHITTON PL APT E
INDIANAPOLIS IN
46220-4799
US

V. Phone/Fax

Practice location:
  • Phone: 317-813-4690
  • Fax:
Mailing address:
  • Phone: 862-800-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: