Healthcare Provider Details

I. General information

NPI: 1518693308
Provider Name (Legal Business Name): NERLY MATHA JEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 NW FEDERAL HWY STE 173
STUART FL
34994-1019
US

IV. Provider business mailing address

9000 BURMA RD STE 109
PALM BEACH GARDENS FL
33403-1606
US

V. Phone/Fax

Practice location:
  • Phone: 954-579-7973
  • Fax:
Mailing address:
  • Phone: 561-508-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: