Provider Demographics
NPI:1558452417
Name:ONI, HAFUSAT ABOSEDE (DO)
Entity Type:Individual
Prefix:DR
First Name:HAFUSAT
Middle Name:ABOSEDE
Last Name:ONI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HAFUSAT
Other - Middle Name:ABOSEDE
Other - Last Name:FAWEHINMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:352-429-5606
Practice Address - Street 1:1296 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-2012
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:352-429-5606
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008846207Q00000X
FLOS9433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018680400Medicaid
OH2682502Medicaid
ON4193351Medicare Oscar/Certification
FL018680400Medicaid