Provider Demographics
NPI:1538752837
Name:ADEGOJU, SIJUWADE ABIOLA
Entity type:Individual
Prefix:MRS
First Name:SIJUWADE
Middle Name:ABIOLA
Last Name:ADEGOJU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIJUWADE
Other - Middle Name:
Other - Last Name:AKIYODE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:ALIEF
Mailing Address - State:TX
Mailing Address - Zip Code:77411-0166
Mailing Address - Country:US
Mailing Address - Phone:832-863-8200
Mailing Address - Fax:
Practice Address - Street 1:2012 E HIGHWAY 90A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2526
Practice Address - Country:US
Practice Address - Phone:832-863-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TB0200X
TX1061710363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral