Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME136266 | FL |
NPI | 1033554902 |
---|---|
Provider Name | Abosede Olatoyosi Adeoshun |
First Address | Rockledge, FL 32955-4306 |
Second Address | Rockledge, FL 32955-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2013 |
Last Update Date | 22/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | FL |
PENDING | MEDICARE (01) | FL |