Provider Demographics
NPI:1003428467
Name:ODOMS-BROWN, PAMELLA OMELDA
Entity type:Individual
Prefix:MRS
First Name:PAMELLA
Middle Name:OMELDA
Last Name:ODOMS-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 SHIRLEY DR.
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712
Mailing Address - Country:US
Mailing Address - Phone:407-883-6220
Mailing Address - Fax:
Practice Address - Street 1:541 SHIRLEY DR.
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712
Practice Address - Country:US
Practice Address - Phone:407-883-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities