Provider Demographics
NPI:1558118414
Name:AYEDUN, OLANIKE OLAMIDE
Entity type:Individual
Prefix:
First Name:OLANIKE
Middle Name:OLAMIDE
Last Name:AYEDUN
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 1:3161 KINGSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7545
Mailing Address - Country:US
Mailing Address - Phone:214-994-7506
Mailing Address - Fax:
Practice Address - Street 1:3161 KINGSWOOD CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7545
Practice Address - Country:US
Practice Address - Phone:214-994-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1155291363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty