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NPI Code Detail

MEDICARE: MS. DEJANAE MIKE RBT

MEDICARE: MS. DEJANAE MIKE RBT
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 : 1659021251
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEJANAE MIKE RBT
Provider Business Mailing Address
First Line : 549 MERRIMAC TER APT D
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33415-3737
Country : US
Telephone Number : 757-338-5067
Fax Number :
Provider Business Practice Location Address
First Line : 1701 MILITARY TRL STE 142
Second Line :
City : JUPITER
State : FL
Zip : 33458-6325
Country : US
Telephone Number : 561-242-1725
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2022
Last Update Date : 03/25/2022

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