Healthcare Provider Details

I. General information

NPI: 1366353955
Provider Name (Legal Business Name): ODINAKA CLEMENT OFODILE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3099 ORANGE CENTER BLVD
ORLANDO FL
32805-4362
US

IV. Provider business mailing address

6656 GUNNELL CT
ORLANDO FL
32809-6525
US

V. Phone/Fax

Practice location:
  • Phone: 407-601-0491
  • 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: