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NPI Code Detail

MEDICARE: NIYA IBEABUCHI

MEDICARE: NIYA IBEABUCHI
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 TechnicianFL

General Provider Information

NPI Number : 1417889684
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIYA IBEABUCHI
Provider Business Mailing Address
First Line : 12276 SAN JOSE BLVD STE 508
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-8618
Country : US
Telephone Number : 904-886-3228
Fax Number : 904-485-8876
Provider Business Practice Location Address
First Line : 12276 SAN JOSE BLVD STE 508
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-8618
Country : US
Telephone Number : 904-886-3228
Fax Number : 904-485-8876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ NIYA IBEABUCHI ” Practice Location

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