Healthcare Provider Details

I. General information

NPI: 1376455568
Provider Name (Legal Business Name): JARED SARLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 MOOREFIELD PARK DR
NORTH CHESTERFIELD VA
23236-3670
US

IV. Provider business mailing address

5506 MILLSTREAM LN
HENRICO VA
23228-1794
US

V. Phone/Fax

Practice location:
  • Phone: 804-985-1050
  • Fax:
Mailing address:
  • Phone: 631-383-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2852480
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: