Healthcare Provider Details

I. General information

NPI: 1326942152
Provider Name (Legal Business Name): RUMBIDZAI MELODY KASHUMBA ODOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE RD
LUTZ FL
33558-8005
US

IV. Provider business mailing address

8606 HUNTERS VILLAGE RD, PMB 622
TAMPA FL
33647
US

V. Phone/Fax

Practice location:
  • Phone: 813-347-1440
  • Fax:
Mailing address:
  • Phone: 813-347-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9295961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: