Healthcare Provider Details

I. General information

NPI: 1124318241
Provider Name (Legal Business Name): OLAWALE SHEKONI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2011
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2399
US

IV. Provider business mailing address

6621 FANNIN ST
HOUSTON TX
77030-2399
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1000
  • Fax: 832-825-5424
Mailing address:
  • Phone: 832-824-1000
  • Fax: 832-825-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW2358
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036136838
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: