Provider Demographics
NPI:1760942338
Name:OSVOLD, DANYKA
Entity Type:Individual
Prefix:
First Name:DANYKA
Middle Name:
Last Name:OSVOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIKA
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, RMHCI
Mailing Address - Street 1:1401 RIVER DR SW
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-4122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 RIVER DR SW
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4122
Practice Address - Country:US
Practice Address - Phone:813-944-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health