Healthcare Provider Details

I. General information

NPI: 1427740554
Provider Name (Legal Business Name): AASIYAH JAFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 MISTY GROVE LN
SANFORD FL
32771-0201
US

IV. Provider business mailing address

349 MISTY GROVE LN
SANFORD FL
32771-0201
US

V. Phone/Fax

Practice location:
  • Phone: 407-267-3402
  • Fax: 407-960-3009
Mailing address:
  • Phone: 407-267-3402
  • Fax: 407-960-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: