Healthcare Provider Details

I. General information

NPI: 1811678261
Provider Name (Legal Business Name): JANIYA DEVAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11808 N OHIO ST
DUNNELLON FL
34431-6724
US

IV. Provider business mailing address

834 N GRIFFITH AVE
CRYSTAL RIVER FL
34429-7669
US

V. Phone/Fax

Practice location:
  • Phone: 352-342-5006
  • Fax:
Mailing address:
  • Phone: 352-257-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23287279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: