Healthcare Provider Details

I. General information

NPI: 1194808022
Provider Name (Legal Business Name): AFOLABI OLAKUNLE SANGOSANYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N E ST SUITE 331
PENSACOLA FL
32501-6339
US

IV. Provider business mailing address

1717 N E ST SUITE 333
PENSACOLA FL
32501-6339
US

V. Phone/Fax

Practice location:
  • Phone: 850-444-1717
  • Fax:
Mailing address:
  • Phone: 850-444-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME89212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: