Healthcare Provider Details

I. General information

NPI: 1861085664
Provider Name (Legal Business Name): CHYNA ODUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 ARMSTRONG BLVD
KISSIMMEE FL
34741-2589
US

IV. Provider business mailing address

743 ZARABROOKE CT
APOPKA FL
32712-1813
US

V. Phone/Fax

Practice location:
  • Phone: 407-559-4854
  • Fax:
Mailing address:
  • Phone:
  • 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: