Provider Demographics
NPI:1831629583
Name:IYEBOTE, DISEIYE
Entity type:Individual
Prefix:
First Name:DISEIYE
Middle Name:
Last Name:IYEBOTE
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 1:1201 CHURCH STREET
Mailing Address - Street 2:545
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:703-615-6034
Mailing Address - Fax:
Practice Address - Street 1:1005 DR. D. B. TODD JR. BOULEVARD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3684
Practice Address - Country:US
Practice Address - Phone:615-327-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18316295832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry