Healthcare Provider Details

I. General information

NPI: 1649110206
Provider Name (Legal Business Name): SALIU AJEDOTUN SHITTU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLZ
BROOKLYN NY
11212-3139
US

IV. Provider business mailing address

2414 WAYBREAD LN
ROSENBERG TX
77471-3082
US

V. Phone/Fax

Practice location:
  • Phone: 718-613-4000
  • Fax:
Mailing address:
  • Phone: 346-287-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1679787998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: