Healthcare Provider Details

I. General information

NPI: 1639817414
Provider Name (Legal Business Name): RACHEL OGUNDAUNSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SE 46TH LN
CAPE CORAL FL
33904-8601
US

IV. Provider business mailing address

17445 ALLENTOWN RD
FORT MYERS FL
33967-2960
US

V. Phone/Fax

Practice location:
  • Phone: 239-687-8707
  • Fax:
Mailing address:
  • Phone: 239-634-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: