MEDICARE: JOHNAE AMOUR NELSON

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
1	106S00000X	Behavior Technician		CT

General Provider Information

NPI Number	:	1255260857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNAE AMOUR NELSON

Provider Business Mailing Address
First Line	:	1375 CHAPEL ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-4416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 CHAPEL ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-4416
Country	:	US
Telephone Number	:	475-392-1286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “ JOHNAE AMOUR NELSON ” Practice Location

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