Provider Demographics
NPI:1659790665
Name:FABUNMI, OLADELE AKINSIKU
Entity Type:Individual
Prefix:
First Name:OLADELE
Middle Name:AKINSIKU
Last Name:FABUNMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLADELE
Other - Middle Name:
Other - Last Name:AKINSIKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:6633 FOREST AVE STE 300
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2612
Practice Address - Country:US
Practice Address - Phone:727-724-8611
Practice Address - Fax:727-724-0425
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35131832207R00000X
FLME164425207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH09111986Medicaid