Healthcare Provider Details

I. General information

NPI: 1053261925
Provider Name (Legal Business Name): TYVION ISAIAH BUFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 ACKLINS CIR
DAYTONA BEACH FL
32119
US

IV. Provider business mailing address

210 ACKLINS CIR
DAYTONA BEACH FL
32119
US

V. Phone/Fax

Practice location:
  • Phone: 863-677-8423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: