Healthcare Provider Details

I. General information

NPI: 1659287340
Provider Name (Legal Business Name): JANESSE MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SAND LAKE RD
ORLANDO FL
32809-7750
US

IV. Provider business mailing address

2839 CLIPPER COVE LN APT 102
KISSIMMEE FL
34741-1069
US

V. Phone/Fax

Practice location:
  • Phone: 407-412-6114
  • Fax:
Mailing address:
  • Phone: 850-496-7611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2856936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: