MEDICARE: JULIANNE ISABELLA FERNANDEZ

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	103K00000X	Behavior Analyst	1-21-54308	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730640582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE ISABELLA FERNANDEZ

Provider Business Mailing Address
First Line	:	1275 POTENZA DR
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-9220
Country	:	US
Telephone Number	:	864-789-2557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 DAIRY RD
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-4046
Country	:	US
Telephone Number	:	321-413-3366
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	07/26/2023

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