MEDICARE: DEZARYIA RAY

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		GA

General Provider Information

NPI Number	:	1396671905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEZARYIA RAY

Provider Business Mailing Address
First Line	:	935 JUSTICE DR
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-3661
Country	:	US
Telephone Number	:	478-663-0673
Fax Number	:

Provider Business Practice Location 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

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

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “ DEZARYIA RAY ” Practice Location

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