Healthcare Provider Details

I. General information

NPI: 1104769017
Provider Name (Legal Business Name): MISS MAEJUAN KARA'SHEA ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CAPULET DR STE 102
SAINT AUGUSTINE FL
32092-4538
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 904-429-3859
  • Fax: 904-429-4416
Mailing address:
  • Phone: 866-610-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberA2279172940000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: