Healthcare Provider Details

I. General information

NPI: 1184547085
Provider Name (Legal Business Name): PBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 LAFAYETTE STREET SW
PALM BAY FL
32809
US

IV. Provider business mailing address

543 LAFAYETTE STREET SW
PALM BAY FL
32809
US

V. Phone/Fax

Practice location:
  • Phone: 929-331-5590
  • Fax: 929-331-5590
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MITSUKA BRUMAIRE
Title or Position: BEHAVIOR ASSISTANT
Credential:
Phone: 929-331-5590