Healthcare Provider Details

I. General information

NPI: 1417896648
Provider Name (Legal Business Name): KYRAH ODUDU MA ,COA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 FAIRMONT AVE SUITE 200 #1018
TOWSON MD
21286
US

IV. Provider business mailing address

849 FAIRMONT AVE SUITE 200 #1018
TOWSON MD
21286
US

V. Phone/Fax

Practice location:
  • Phone: 410-870-9691
  • Fax:
Mailing address:
  • Phone: 410-870-9691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: