Angela Wallace Fadahunsi, MD

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

R5721 Issued in TX

Practice address

611 S Highway 78 Ste 102
Wylie, TX 75098

Phone

(972) 954-9826

NPI assigned

Apr 18, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Angela Latresha Wallace Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Allergy/Immunology

Education

University of Texas Medical Branch at Galveston, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: afadahunsi1440743@direct.sw.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Allergy & Asthma Care of Wylie, PLLC

  • Allergy & Immunology Physician
  • Wylie, TX
  • NPI 1134926561
  Medicare reassignment NPD Authorized official
• Healthtexas Provider Network

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1760488936

  Internal Medicine

  Medicare reassignment NPD
• Healthtexas Provider Network

  • Family Medicine Physician
  • Plano, TX
  • NPI 1003811639
  NPD
• Healthtexas Provider Network

  • Anesthesiology Physician
  • Lakeway, TX
  • NPI 1104714583
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1780028951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 S HIGHWAY 78 STE 102",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750984085",
            "telephone_number": "972-954-9826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 S HIGHWAY 78 STE 102",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "75098",
            "telephone_number": "972-954-9826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADAHUNSI",
        "first_name": "ANGELA",
        "middle_name": "WALLACE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-18",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "R5721",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "TX",
            "license": "R5721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "WALLACE",
            "middle_name": "LATRESHA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Beth Ann Evans, D.C.
• Jaelyn Monique Evans, SLP
• Lisa Carol Evans, M.A.
• Excel Medical Billing & Healthcare Services
• Ez Health RCM LLC
• Nora R Fallon, PA-C
• Jessica Dyann Fambrough, PTA
• Family Physicians of Wylie PA
• Fannin County Hospital Authority
• Jason Michael Fannin

• Allergy & Immunology Physician in Wylie, TX
• Providers in Wylie, TX by specialty
• Allergy & Immunology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.