Provider Demographics
NPI:1548498561
Name:LADELE, AYODEJI (DO)
Entity type:Individual
Prefix:
First Name:AYODEJI
Middle Name:
Last Name:LADELE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:AYODEJI
Other - Last Name:LADELE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1410 LPGA BLVD STE 136
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5146
Mailing Address - Country:US
Mailing Address - Phone:386-274-4750
Mailing Address - Fax:386-274-2499
Practice Address - Street 1:1410 LPGA BLVD STE 136
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5146
Practice Address - Country:US
Practice Address - Phone:386-274-4750
Practice Address - Fax:386-274-2499
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 12334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine