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General NPI Number Information
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NPI Number | 1568359941
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Entity Type | Organization
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Legal Business Name | SPECIALTY FAMILY MEDICINE
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1599 NW 9TH AVE STE 4
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City | BOCA RATON
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State | FL
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Zip | 33486-1310
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Country | US
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Telephone | 561-409-2759
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Fax | 561-409-2963
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Provider Business Mailing Address
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Address Line | 3210 SAINT CHARLES PL
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City | BOCA RATON
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State | FL
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Zip | 33434-5307
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Country | US
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Telephone | 276-252-7007
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. AYOKUNLE FATADE
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Credential | DO
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Telephone | 276-252-7007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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