Provider Demographics
NPI:1083097505
Name:ENIAYEDUN, OYEDELE AUSTIN
Entity Type:Individual
Prefix:MR
First Name:OYEDELE
Middle Name:AUSTIN
Last Name:ENIAYEDUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 CASSATT AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1606
Mailing Address - Country:US
Mailing Address - Phone:321-245-7458
Mailing Address - Fax:
Practice Address - Street 1:5019 CASSATT AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1606
Practice Address - Country:US
Practice Address - Phone:321-245-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12600310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility