Provider Demographics
NPI:1154772986
Name:ODUNSI, OLUWATOBILOBA
Entity type:Individual
Prefix:
First Name:OLUWATOBILOBA
Middle Name:
Last Name:ODUNSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 LEGACY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1210
Mailing Address - Country:US
Mailing Address - Phone:469-777-4691
Mailing Address - Fax:469-777-4542
Practice Address - Street 1:11330 LEGACY DR STE 103
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1210
Practice Address - Country:US
Practice Address - Phone:469-777-4691
Practice Address - Fax:469-777-4542
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012700172084P0800X
SCLL398922084P0800X
WAMD610740082084P0800X
TXT54192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry