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General NPI Number Information
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NPI Number | 1962376434
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Entity Type | Individual
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Provider Name | KEYANA JANAI GORUM
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Gender | Female
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Dates
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Enumeration Date | 09/30/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 12735 GRAN BAY PKWY W STE 204
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City | JACKSONVILLE
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State | FL
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Zip | 32258-4499
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Country | US
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Telephone | 904-506-4267
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Fax |
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Provider Business Mailing Address
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Address Line | 4075 COYOTE CT
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City | MIDDLEBURG
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State | FL
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Zip | 32068-2225
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Country | US
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Telephone | 760-828-5505
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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 |
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License Number State | FL
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