Healthcare Provider Details

I. General information

NPI: 1417747908
Provider Name (Legal Business Name): MICHELLE JUDITH JEUDY OLOTCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SW 23RD CT
FORT LAUDERDALE FL
33312-4327
US

IV. Provider business mailing address

3101 SW 23RD CT
FORT LAUDERDALE FL
33312-4327
US

V. Phone/Fax

Practice location:
  • Phone: 954-608-1997
  • Fax:
Mailing address:
  • Phone: 954-608-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number9304486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: