Provider Demographics
NPI:1598912347
Name:OSUNDE-SODIMU, TEMITAYO (NP)
Entity type:Individual
Prefix:
First Name:TEMITAYO
Middle Name:
Last Name:OSUNDE-SODIMU
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MARK IV PKWY UNIT 162254
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-5252
Mailing Address - Country:US
Mailing Address - Phone:214-272-9008
Mailing Address - Fax:
Practice Address - Street 1:1230 RIVER BEND DR STE 107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4916
Practice Address - Country:US
Practice Address - Phone:214-272-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX706185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321060101Medicaid