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General NPI Number Information
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NPI Number | 1962713461
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Entity Type | Individual
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Provider Name | ADEDOYIN OKUSANYA MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 6613 49TH ST N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-5728
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Country | US
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Telephone | 727-527-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 8116 RIVERMONT WAY
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637
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Country | US
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Telephone | 813-482-5734
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME129198
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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