Provider Demographics
NPI:1497910806
Name:HUDSON, SCOTTY D (AP)
Entity Type:Individual
Prefix:MR
First Name:SCOTTY
Middle Name:D
Last Name:HUDSON
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 S VOLUSIA AVE STE C4
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7626
Mailing Address - Country:US
Mailing Address - Phone:407-690-7696
Mailing Address - Fax:407-610-0287
Practice Address - Street 1:2445 S VOLUSIA AVE STE C4
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7626
Practice Address - Country:US
Practice Address - Phone:407-690-7696
Practice Address - Fax:407-610-0287
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2462171100000X
FLAP 2462171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist