Healthcare Provider Details

I. General information

NPI: 1912824715
Provider Name (Legal Business Name): MR. DEVANTE ANDREW WYCHE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 DENTON BLVD NW APT 64
FORT WALTON BEACH FL
32547-1663
US

IV. Provider business mailing address

937 DENTON BLVD NW APT 64
FORT WALTON BEACH FL
32547-1663
US

V. Phone/Fax

Practice location:
  • Phone: 850-376-7377
  • Fax:
Mailing address:
  • Phone: 850-376-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA109542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: