Individual
DR. SUWEBATU T ODUNSI-SHIYANBADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
647 N MILLER RD STE B, MANSFIELD, TX 76063-6180
(817) 760-7969
(817) 760-7976
Mailing address
PO BOX 35629, DALLAS, TX 75235-0629
(214) 424-2213
(142) 312-1592
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
M4404
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
638925000
—
MN
01
—
M4404
MEDICAL LICENSE
TX
01
—
P0147446
DPS
TX
Enumeration date
09/30/2006
Last updated
03/07/2023
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