Provider Demographics
NPI:1427217165
Name:OMOHUNDRO, ALICE K (AP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:K
Last Name:OMOHUNDRO
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-8900
Mailing Address - Country:US
Mailing Address - Phone:772-913-0299
Mailing Address - Fax:772-589-9027
Practice Address - Street 1:735 COMMERCE CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3136
Practice Address - Country:US
Practice Address - Phone:772-913-0299
Practice Address - Fax:772-589-9027
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2431171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist