Healthcare Provider Details

I. General information

NPI: 1215915152
Provider Name (Legal Business Name): AKINYEMI OLUTOYE AJAYI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 W FAIRBANKS AVE
WINTER PARK FL
32789-3385
US

IV. Provider business mailing address

2660 W FAIRBANKS AVE
WINTER PARK FL
32789-3385
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-2767
  • Fax: 407-898-9443
Mailing address:
  • Phone: 407-898-2767
  • Fax: 407-898-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number84664
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberME84664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: