Provider Demographics
NPI:1780295485
Name:AIYEOJENKU, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:AIYEOJENKU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:S
Other - Last Name:ADETORO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MADIAN NAME
Mailing Address - Street 1:6102 SKILLMAN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7811
Mailing Address - Country:US
Mailing Address - Phone:214-335-3867
Mailing Address - Fax:
Practice Address - Street 1:6102 SKILLMAN ST STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7811
Practice Address - Country:US
Practice Address - Phone:214-335-3867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1021329363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty