Healthcare Provider Details

I. General information

NPI: 1427797273
Provider Name (Legal Business Name): ABDUL-AZIZ ADEWALE SHITTOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/13/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S RAILROAD ST
TAMAQUA PA
18252-1927
US

IV. Provider business mailing address

1700 ST LUKES BLVD
EASTON PA
18045-5670
US

V. Phone/Fax

Practice location:
  • Phone: 570-645-0661
  • Fax:
Mailing address:
  • Phone: 484-526-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT225830
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT225830
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: