MEDICARE: DESTANEE GREENE

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		FL

General Provider Information

NPI Number	:	1427903913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTANEE GREENE

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2868 MAHAN DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5468
Country	:	US
Telephone Number	:	850-391-6060
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ DESTANEE GREENE ” Practice Location

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