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NPI Code Detail

MEDICARE: JUSTIN BASDEO

MEDICARE: JUSTIN BASDEO
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 Technician

General Provider Information

NPI Number : 1518668748
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN BASDEO
Provider Business Mailing Address
First Line : PO BOX 631278
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-1278
Country : US
Telephone Number : 800-356-4049
Fax Number : 941-485-0519
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 : 800-356-4049
Fax Number : 941-485-0519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2023
Last Update Date : 03/14/2023

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Directions to “ JUSTIN BASDEO ” Practice Location

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