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General NPI Number Information
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NPI Number | 1720884950
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Entity Type | Individual
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Provider Name | AMANDA JUNCO NOVO
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Gender | Female
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 566 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-5108
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Country | US
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Telephone | 772-201-0173
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Fax | 772-209-7631
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Provider Business Mailing Address
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Address Line | 2895 SW 144TH PL
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City | MIAMI
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State | FL
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Zip | 33175-7444
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Country | US
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Telephone | 305-609-1401
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-411371
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License Number State | FL
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