Healthcare Provider Details

I. General information

NPI: 1548042948
Provider Name (Legal Business Name): JANAE MASHELL ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2928 WELLINGTON CIR STE 201
TALLAHASSEE FL
32309-6879
US

IV. Provider business mailing address

PO BOX 10827
TALLAHASSEE FL
32302-2827
US

V. Phone/Fax

Practice location:
  • Phone: 850-521-0242
  • Fax:
Mailing address:
  • Phone: 850-521-0242
  • Fax: 850-521-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: