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General NPI Number Information
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NPI Number | 1104456961
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Entity Type | Individual
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Provider Name | OLUBUKOLA E SHODIYA
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Gender | Female
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Dates
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Enumeration Date | 01/21/2020
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 2921 LANDMARK PL STE 215
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City | MADISON
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State | WI
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Zip | 53713-4248
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Country | US
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Telephone | 708-713-1017
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Fax |
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Provider Business Mailing Address
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Address Line | 16514 S SUN MEADOW DR
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City | LOCKPORT
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State | IL
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Zip | 60441-5078
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Country | US
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Telephone | 708-713-1017
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 115698
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1681833
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71013331A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.020728
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License Number State | IL
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