Provider Demographics
NPI:1982497806
Name:SHODUNKE, SIMISOLA A
Entity type:Individual
Prefix:MRS
First Name:SIMISOLA
Middle Name:A
Last Name:SHODUNKE
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 1:24703 BEEBALM TRL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-5582
Mailing Address - Country:US
Mailing Address - Phone:281-406-5964
Mailing Address - Fax:
Practice Address - Street 1:24703 BEEBALM TRL
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-5582
Practice Address - Country:US
Practice Address - Phone:281-406-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty