Healthcare Provider Details

I. General information

NPI: 1780598789
Provider Name (Legal Business Name): KAIYA WOODARD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 WILDWOOD LN
PALM COAST FL
32137
US

IV. Provider business mailing address

1333 BEACON DRIVE
DAYTONA BEACH FL
32117
US

V. Phone/Fax

Practice location:
  • Phone: 386-251-3350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-2854344
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: