Healthcare Provider Details

I. General information

NPI: 1265253413
Provider Name (Legal Business Name): JASON JOHN ESPOSITO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HEALTH BLVD
DAYTONA BEACH FL
32114-1558
US

IV. Provider business mailing address

43 BLACK ALDER DR
PALM COAST FL
32137-7358
US

V. Phone/Fax

Practice location:
  • Phone: 386-267-3161
  • Fax:
Mailing address:
  • Phone: 630-965-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: