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General NPI Number Information
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NPI Number | 1639766199
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Entity Type | Individual
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Provider Name | FADEKEMI SULIAT OLUDE APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 444 E BOSTON POST RD
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City | MAMARONECK
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State | NY
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Zip | 10543-3708
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Country | US
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Telephone | 713-291-8625
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Fax |
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Provider Business Mailing Address
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Address Line | 3449 AVA DR
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-2274
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Country | US
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Telephone | 713-291-8625
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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 | 1023087
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License Number State | TX
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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 | C-APN.0003755-C-NP
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License Number State | CO
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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 | 403381
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License Number State | NY
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