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NPI Code Detail

MEDICARE: DECLAN JAMES RUSSELL

MEDICARE: DECLAN JAMES RUSSELL
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 TechnicianRBT-26-512962

General Provider Information

NPI Number : 1366376899
Entity Type Code : Individual
Provider Name (Legal Business Name) : DECLAN JAMES RUSSELL
Provider Business Mailing Address
First Line : 4014 GUNN HWY STE 140
Second Line :
City : TAMPA
State : FL
Zip : 33618-8787
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4014 GUNN HWY STE 140
Second Line :
City : TAMPA
State : FL
Zip : 33618-8787
Country : US
Telephone Number : 813-923-9905
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2026
Last Update Date : 06/10/2026

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Directions to “ DECLAN JAMES RUSSELL ” Practice Location

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