OrganizationActive
Idera Behavioral Health PLLC
NPI 1053287045 · Behavioral Neurology & Neuropsychiatry Physician · Grand Prairie, TX
Provider details
- NPI number
- 1053287045
- Entity type
- Organization
- Primary specialty
- Behavioral Neurology & Neuropsychiatry PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Babatunde Shittu, Nurse Practitioner(817) 217-0662
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
3036 Larreta
Grand Prairie, TX 75054-6794
Phone: (817) 217-0662
Approximate (ZIP-level) locationGet directions
Mailing address
3036 Larreta
Grand Prairie, TX 75054-6794
Registry dates
- Enumerated
- 2025-10-15
- Last updated
- 2025-10-15
- Certified
- 2025-10-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.