Provider Demographics
NPI:1740258516
Name:FAYIGA, ADEBAYO OLAYINKA (MD)
Entity type:Individual
Prefix:
First Name:ADEBAYO
Middle Name:OLAYINKA
Last Name:FAYIGA
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 1:7645 SW 168TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4891
Mailing Address - Country:US
Mailing Address - Phone:305-255-0633
Mailing Address - Fax:
Practice Address - Street 1:7645 SW 168TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4891
Practice Address - Country:US
Practice Address - Phone:305-255-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040874207P00000X
FLME40874208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96952OtherBCBS
FL370566800Medicaid
P00298625OtherRR MCR
FL96952OtherBCBS
FL370566800Medicaid
FL96952CMedicare PIN
P00298625OtherRR MCR