Healthcare Provider Details

I. General information

NPI: 1336966431
Provider Name (Legal Business Name): MISS LISSBIRD JEUNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2024
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 NE 13TH AVE
NORTH MIAMI BEACH FL
33162-4607
US

IV. Provider business mailing address

461 NE 174TH ST
NORTH MIAMI BEACH FL
33162-1943
US

V. Phone/Fax

Practice location:
  • Phone: 305-952-3161
  • Fax:
Mailing address:
  • Phone: 786-448-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: