Healthcare Provider Details

I. General information

NPI: 1982395109
Provider Name (Legal Business Name): JACKELINE RODRIGUEZ ESCANDELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 NW 25TH ST STE 220
MIAMI FL
33122-1714
US

IV. Provider business mailing address

5643 BASIL DR
WEST PALM BEACH FL
33415-7013
US

V. Phone/Fax

Practice location:
  • Phone: 305-560-8236
  • Fax: 305-433-7314
Mailing address:
  • Phone: 270-244-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-260877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: