Individual
AUTUMN KRYSTI OMORUYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 S FEDERAL HWY, FORT LAUDERDALE, FL 33316-2619
(954) 728-8080
(954) 779-2316
Mailing address
1401 S FEDERAL HWY, FORT LAUDERDALE, FL 33316-2619
(954) 728-8080
(954) 779-2316
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119712700
—
FL
Enumeration date
08/24/2023
Last updated
10/10/2023
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