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General NPI Number Information
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NPI Number | 1346738135
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Entity Type | Individual
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Provider Name | OLADAYO SIMEON FARODOYE PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 607 WESTHAVEN RD
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City | COPPELL
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State | TX
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Zip | 75019-2504
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Country | US
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Telephone | 314-891-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 2807 ALLEN ST # 2109
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City | DALLAS
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State | TX
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Zip | 75204-1031
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Country | US
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Telephone |
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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 | 2020006139
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License Number State | MO
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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 | 4704330380
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License Number State | MI
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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 | 1113179
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License Number State | TX
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