MEDICARE: PHIESHA MENTORE

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	RBT-25-475146	FL

General Provider Information

NPI Number	:	1972479418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHIESHA MENTORE

Provider Business Mailing Address
First Line	:	1001 N MARTIN LUTHER KING JR AVE APT 1903
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33755-3336
Country	:	US
Telephone Number	:	727-558-9640
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 N MARTIN LUTHER KING JR AVE APT 1903
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33755-3336
Country	:	US
Telephone Number	:	727-558-9640
Fax Number	:

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

Provider Enumeration Date	:	10/13/2025
Last Update Date	:	10/13/2025

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Directions to “ PHIESHA MENTORE ” Practice Location

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