=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730077546
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JALIYAH JOENISHA JONES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2025
-----------------------------------------------------
Last Update Date | 06/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2059 NOBSCOT PL
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-8421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-417-4834
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2059 NOBSCOT PL
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-8421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-417-4834
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | J520-430-03-825-0
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------