Provider Demographics
NPI:1891085189
Name:AYO AMU, MORIAM O (MD)
Entity type:Individual
Prefix:DR
First Name:MORIAM
Middle Name:O
Last Name:AYO AMU
Suffix:
Gender:F
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:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:10141 BIG BEND RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7419
Practice Address - Country:US
Practice Address - Phone:813-397-1270
Practice Address - Fax:813-397-1271
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009249400Medicaid
FL009249400Medicaid