Healthcare Provider Details

I. General information

NPI: 1548778863
Provider Name (Legal Business Name): MS. SHALAINNA YEMISI OGUNBIYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 S LOOP W
HOUSTON TX
77054-2662
US

IV. Provider business mailing address

5514 GRIGGS RD APT 411
HOUSTON TX
77021-3763
US

V. Phone/Fax

Practice location:
  • Phone: 832-574-1155
  • Fax: 832-485-0595
Mailing address:
  • Phone: 832-877-5601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: