Provider Demographics
NPI:1568359941
Name:SPECIALTY FAMILY MEDICINE
Entity type:Organization
Organization Name:SPECIALTY FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AYOKUNLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FATADE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:276-252-7007
Mailing Address - Street 1:3210 SAINT CHARLES PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5307
Mailing Address - Country:US
Mailing Address - Phone:276-252-7007
Mailing Address - Fax:
Practice Address - Street 1:1599 NW 9TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1310
Practice Address - Country:US
Practice Address - Phone:561-409-2759
Practice Address - Fax:561-409-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain