Healthcare Provider Details

I. General information

NPI: 1205792371
Provider Name (Legal Business Name): JAHN YOURIKA MASSANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13650 NW 8TH ST
SUNRISE FL
33325-6277
US

IV. Provider business mailing address

11379 LAKEVIEW DR
CORAL SPRINGS FL
33071-6332
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 954-658-2038
  • Fax:

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: