Provider Demographics
NPI:1568785921
Name:OKELOLA, FADEKE TOYIN (PA-C)
Entity type:Individual
Prefix:
First Name:FADEKE
Middle Name:TOYIN
Last Name:OKELOLA
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:FADEKE
Other - Middle Name:TOYIN
Other - Last Name:ADEWOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 392929
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9900
Mailing Address - Country:US
Mailing Address - Phone:731-461-2915
Mailing Address - Fax:713-461-5307
Practice Address - Street 1:18652 MCKAY DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5726
Practice Address - Country:US
Practice Address - Phone:281-446-1520
Practice Address - Fax:713-461-5307
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06672363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical