Provider Demographics
NPI:1841836624
Name:SOBANDE-AMON, FOLASHADE ABEBI
Entity type:Individual
Prefix:
First Name:FOLASHADE
Middle Name:ABEBI
Last Name:SOBANDE-AMON
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 1:1205 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7581
Mailing Address - Country:US
Mailing Address - Phone:817-800-2641
Mailing Address - Fax:
Practice Address - Street 1:1205 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7581
Practice Address - Country:US
Practice Address - Phone:817-800-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2019055006363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health