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NPI Code Detail

MEDICARE: MR. OLUSEGUN ABIODUN SHOROYE BA

MEDICARE:  MR. OLUSEGUN ABIODUN SHOROYE  BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1447560941
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OLUSEGUN ABIODUN SHOROYE BA
Provider Business Mailing Address
First Line : 2615 W GARY AVE UNIT 1060
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-6489
Country : US
Telephone Number : 702-487-6074
Fax Number :
Provider Business Practice Location Address
First Line : 3450 W CHEYENNE AVE STE 500
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-8225
Country : US
Telephone Number : 702-631-0230
Fax Number : 702-631-0809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2010
Last Update Date : 10/18/2010

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Directions to “ MR. OLUSEGUN ABIODUN SHOROYE BA” Practice Location

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