Provider Demographics
NPI:1053542712
Name:ADEKOYA, SAIDAT YETUNDE (PA)
Entity type:Individual
Prefix:MS
First Name:SAIDAT
Middle Name:YETUNDE
Last Name:ADEKOYA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18400 KATY FWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1287
Mailing Address - Country:US
Mailing Address - Phone:832-522-8116
Mailing Address - Fax:
Practice Address - Street 1:18400 KATY FWY STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094
Practice Address - Country:US
Practice Address - Phone:832-522-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013274-1363A00000X
TXPA10769363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392845901Medicaid
TX392845902Medicaid