MEDICARE: DERRIYAH MONTGOMERY

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	:	1538028881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRIYAH MONTGOMERY

Provider Business Mailing Address
First Line	:	7886 ECHO SPRINGS RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0284
Country	:	US
Telephone Number	:	904-228-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	6859 BELFORT OAKS PL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6242
Country	:	US
Telephone Number	:	718-215-5311
Fax Number	:	718-865-5165

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “ DERRIYAH MONTGOMERY ” Practice Location

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