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General NPI Number Information
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NPI Number | 1447356803
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Entity Type | Individual
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Provider Name | OLUBUKUNOLA ADESANYA MD
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 1400 S COULTER ST
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City | AMARILLO
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State | TX
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Zip | 79106-1786
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Country | US
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Telephone | 806-354-5630
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Fax | 806-354-5689
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Provider Business Mailing Address
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Address Line | 1400 WALLACE BLVD ATTN: CREDENTIALING DEPT
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City | AMARILLO
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State | TX
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Zip | 79106-1708
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Country | US
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Telephone | 806-354-5630
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Fax | 806-354-5689
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 2003-0634
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | N4234
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License Number State | TX
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