Healthcare Provider Details

I. General information

NPI: 1720719305
Provider Name (Legal Business Name): MONIKA ANNA OLBRYCHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22518 SW 94TH PATH
CUTLER BAY FL
33190-1264
US

IV. Provider business mailing address

22518 SW 94TH PATH
CUTLER BAY FL
33190-1264
US

V. Phone/Fax

Practice location:
  • Phone: 954-873-0794
  • Fax:
Mailing address:
  • Phone: 954-873-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: