Fantastic Wound Care LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

FANTASTIC WOUND CARE LLC

Practice address

2580 Metrocentre Boulevard
Suite 5
West Palm Beach, FL 33407

Phone

(561) 602-9988

NPI assigned

Apr 17, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Olayemi Olajide Oslyemi, M.D

Title

President

Phone

(561) 602-9988

Specialties & licenses 4

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1265929012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2580 METROCENTRE BOULEVARD",
            "address_2": "SUITE 5",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "33407",
            "telephone_number": "561-602-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2580 METROCENTRE BOULEVARD",
            "address_2": "SUITE 5",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "33407",
            "telephone_number": "561-602-9988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANTASTIC WOUND CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "OSLYEMI",
        "authorized_official_first_name": "OLAYEMI",
        "authorized_official_middle_name": "OLAJIDE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-602-9988",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WX1500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Ostomy Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ao Fang
• Jade Fang, A.P.
• Keh Nan Fang
• Paige Ellen Fant, LCSW, MCAP, ICADC
• Fantastic Wound Care Inc
• Mariela De Lourdes Fantauzzi
• Susan Fante, CRNA
• Bambi D Fanto, M.S.
• Frank Fanto
• Sam Michael Faradyan, M.D.

• Clinic/Center in West Palm Beach, FL
• Providers in West Palm Beach, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.