MEDICARE: MS. QUIANA TIESHEIA JACKSON-ASHE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1134098692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. QUIANA TIESHEIA JACKSON-ASHE

Provider Business Mailing Address
First Line	:	350 FAIRWAY DR STE 101
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1834
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

Provider Business Practice Location Address
First Line	:	360 BLOOMFIELD AVE STE 301
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-2700
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	12/01/2025

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