Provider Demographics
NPI:1306832456
Name:LAYENI, KEHINDE A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEHINDE
Middle Name:A
Last Name:LAYENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 MAYO DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4301
Mailing Address - Country:US
Mailing Address - Phone:352-253-0003
Mailing Address - Fax:352-253-0016
Practice Address - Street 1:1691 MAYO DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4301
Practice Address - Country:US
Practice Address - Phone:352-253-0003
Practice Address - Fax:352-253-0016
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2011-09-28
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
FLME0062765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37125400Medicaid
FL37125400Medicaid
FLF35840Medicare UPIN