Provider Demographics
NPI:1508928722
Name:CANFIELD, ODALIA SANDRA (MED)
Entity Type:Individual
Prefix:MS
First Name:ODALIA
Middle Name:SANDRA
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:CANFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:2150 PARK AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789
Mailing Address - Country:US
Mailing Address - Phone:407-645-2545
Mailing Address - Fax:407-645-3507
Practice Address - Street 1:2150 PARK AVE NORTH
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-645-2545
Practice Address - Fax:407-645-3507
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MH263101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor