Provider Demographics
NPI:1528754025
Name:EDALERE, FEYISAYO OMOLOLA (MD)
Entity type:Individual
Prefix:
First Name:FEYISAYO
Middle Name:OMOLOLA
Last Name:EDALERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17235 STRATFORD GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7380
Mailing Address - Country:US
Mailing Address - Phone:832-762-6758
Mailing Address - Fax:
Practice Address - Street 1:FAMILY HEALTH CENTER, 3401 NORTH BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-381-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program