Provider Demographics
NPI:1417747908
Name:JEUDY OLOTCH, MICHELLE JUDITH
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JUDITH
Last Name:JEUDY OLOTCH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 SW 23RD CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4327
Mailing Address - Country:US
Mailing Address - Phone:954-608-1997
Mailing Address - Fax:
Practice Address - Street 1:3101 SW 23RD CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-4327
Practice Address - Country:US
Practice Address - Phone:954-608-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9304486163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health