Healthcare Provider Details

I. General information

NPI: 1124882295
Provider Name (Legal Business Name): JU'NELLE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 CYRESS GROVE DR
EUSTIS FL
32736
US

IV. Provider business mailing address

3209 CYRESS GROVE DR
EUSTIS FL
32736
US

V. Phone/Fax

Practice location:
  • Phone: 762-224-2083
  • Fax: 973-888-1377
Mailing address:
  • Phone:
  • Fax: 973-888-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-326089
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: