Healthcare Provider Details

I. General information

NPI: 1720890106
Provider Name (Legal Business Name): DWEH PAYLEH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5302 CATTLE CROSSING WAY
JACKSONVILLE FL
32226-4760
US

IV. Provider business mailing address

5302 CATTLE CROSSING WAY
JACKSONVILLE FL
32226-4760
US

V. Phone/Fax

Practice location:
  • Phone: 904-253-5822
  • Fax:
Mailing address:
  • Phone: 904-253-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number04167305Z
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: