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General NPI Number Information
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NPI Number | 1639730096
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Entity Type | Individual
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Provider Name | BOGDANA JALIU PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 267 JOHN KNOX RD STE 105
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6692
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Country | US
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Telephone | 678-900-7149
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Fax |
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Provider Business Mailing Address
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Address Line | 2309 OLD BAINBRIDGE RD APT 1002B
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City | TALLAHASSEE
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State | FL
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Zip | 32303-3850
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Country | US
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Telephone | 678-900-7149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY10457
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License Number State | FL
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