Healthcare Provider Details

I. General information

NPI: 1558164293
Provider Name (Legal Business Name): MRS. BUSOLA OGUNGBILE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8423 ASTER GLEN WAY
ROSHARON TX
77583-1912
US

IV. Provider business mailing address

8423 ASTER GLEN WAY
ROSHARON TX
77583-1912
US

V. Phone/Fax

Practice location:
  • Phone: 203-243-4731
  • Fax:
Mailing address:
  • Phone: 203-243-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: