MEDICARE: JORDYN MASTROSIMONE

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	RBT-24-327334	FL
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1538843305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDYN MASTROSIMONE

Provider Business Mailing Address
First Line	:	4306 WILLOWCREST CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-2629
Country	:	US
Telephone Number	:	954-662-2688
Fax Number	:

Provider Business Practice Location Address
First Line	:	4306 WILLOWCREST CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-2629
Country	:	US
Telephone Number	:	954-662-2688
Fax Number	:

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

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/25/2024

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Directions to “ JORDYN MASTROSIMONE ” Practice Location

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