MEDICARE: CHARA LACTATION CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1013875988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARA LACTATION CARE

Provider Business Mailing Address
First Line	:	4706 SHORTGRASS FIELD TRL
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6884
Country	:	US
Telephone Number	:	281-772-6716
Fax Number	:

Provider Business Practice Location Address
First Line	:	4706 SHORTGRASS FIELD TRL
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6884
Country	:	US
Telephone Number	:	281-772-6716
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLUBUNMI CORDERO
Credential	:	FNP-BC, IBCLC
Telephone Number	:	281-772-6716

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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