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NPI Code Detail

MEDICARE: KHAMEIL MAKAYLA JORDAN

MEDICARE: KHAMEIL MAKAYLA JORDAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianSC

General Provider Information

NPI Number : 1205785060
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHAMEIL MAKAYLA JORDAN
Provider Business Mailing Address
First Line : 350 FAIRWAY DR STE 101
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33441-1834
Country : US
Telephone Number : 877-418-2978
Fax Number : 866-500-2186
Provider Business Practice Location Address
First Line : 1320 MAIN ST STE 300
Second Line :
City : COLUMBIA
State : SC
Zip : 29201-3266
Country : US
Telephone Number : 839-213-4505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2026
Last Update Date : 01/26/2026

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Directions to “ KHAMEIL MAKAYLA JORDAN ” Practice Location

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