Provider Demographics
NPI:1780214502
Name:WYCHE, GODWIN DEWAYNE II
Entity Type:Individual
Prefix:MR
First Name:GODWIN
Middle Name:DEWAYNE
Last Name:WYCHE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WESTHALL LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7203
Mailing Address - Country:US
Mailing Address - Phone:800-840-2528
Mailing Address - Fax:
Practice Address - Street 1:14644 KRISTENRIGHT LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-5305
Practice Address - Country:US
Practice Address - Phone:979-479-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health