MEDICARE: JEMILY AVILA

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	106E00000X	Assistant Behavior Analyst	0-16-7561	FL
2	103K00000X	Behavior Analyst	1-22-63397	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376901421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEMILY AVILA

Provider Business Mailing Address
First Line	:	4575 SE DIXIE HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-6826
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

Provider Business Practice Location Address
First Line	:	5420 NW 33RD AVE STE 6
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6387
Country	:	US
Telephone Number	:	954-271-2323
Fax Number	:	772-675-9100

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

Provider Enumeration Date	:	02/04/2016
Last Update Date	:	01/10/2023

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Directions to “ JEMILY AVILA ” Practice Location

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