Healthcare Provider Details

I. General information

NPI: 1487228581
Provider Name (Legal Business Name): MARY ABIODUN ADOYI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ADEKIYA

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MAITLAND CENTER PKWY STE 310
MAITLAND FL
32751-7442
US

IV. Provider business mailing address

2400 MAITLAND CENTER PKWY STE 310
MAITLAND FL
32751-7442
US

V. Phone/Fax

Practice location:
  • Phone: 352-329-1800
  • Fax: 352-329-1810
Mailing address:
  • Phone: 352-329-1800
  • Fax: 352-329-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPACN79
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number548-P.A.
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberPACN79
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9165
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: