MEDICARE: RASHIDAT N OKUBOYE MA, CPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician	640918060014	FL

General Provider Information

NPI Number	:	1881449692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RASHIDAT N OKUBOYE MA, CPT

Provider Business Mailing Address
First Line	:	1850 FULLER DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33755-1928
Country	:	US
Telephone Number	:	727-303-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	40148 US HIGHWAY 19 N
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-8333
Country	:	US
Telephone Number	:	727-303-8787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/23/2024

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