Healthcare Provider Details

I. General information

NPI: 1265258321
Provider Name (Legal Business Name): JONAS IANNARELLI RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 STATE ROAD 207 STE 2B
ST AUGUSTINE FL
32084-4753
US

IV. Provider business mailing address

235 STATE ROAD 207 STE 2B
ST AUGUSTINE FL
32084-4753
US

V. Phone/Fax

Practice location:
  • Phone: 904-217-3103
  • Fax:
Mailing address:
  • Phone: 904-217-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-19-9566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: