Provider Demographics
NPI:1124484902
Name:SHODEKE, ADEWALE
Entity type:Individual
Prefix:MR
First Name:ADEWALE
Middle Name:
Last Name:SHODEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 BRIDLE PATH DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-2039
Mailing Address - Country:US
Mailing Address - Phone:972-679-6999
Mailing Address - Fax:
Practice Address - Street 1:2217 BRIDLE PATH DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-2039
Practice Address - Country:US
Practice Address - Phone:972-679-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor