MEDICARE: MRS. KYRAH ODUDU MA ,COA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	MD
2	390200000X	Student in an Organized Health Care Education/Training Program	MD
3	374J00000X	Doula	MD
4	133NN1002X	Nutrition Education Nutritionist	MD
5	174H00000X	Health Educator	MD

General Provider Information

NPI Number	:	1417896648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KYRAH ODUDU MA ,COA

Provider Business Mailing Address
First Line	:	849 FAIRMONT AVE
Second Line	:	SUITE 200 #1018
City	:	TOWSON
State	:	MD
Zip	:	21286
Country	:	US
Telephone Number	:	410-870-9691
Fax Number	:

Provider Business Practice Location Address
First Line	:	849 FAIRMONT AVE
Second Line	:	SUITE 200 #1018
City	:	TOWSON
State	:	MD
Zip	:	21286
Country	:	US
Telephone Number	:	410-870-9691
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	05/28/2026

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