Healthcare Provider Details

I. General information

NPI: 1679417166
Provider Name (Legal Business Name): SEED & SANCTUARY WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 FAIRMOUNT AVE SUITE 200 #1018
TOWSON MD
21286
US

IV. Provider business mailing address

849 FAIRMOUNT AVE SUITE 200 #1018
TOWSON MD
21286
US

V. Phone/Fax

Practice location:
  • Phone: 727-776-1625
  • Fax:
Mailing address:
  • Phone: 727-776-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: KYRAH ODUDU
Title or Position: MANAGING MEMBER
Credential: MA
Phone: 727-776-1625