MEDICARE: NYIANNI MATHIS 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
1	106S00000X	Behavior Technician	RBT-25-498787	FL

General Provider Information

NPI Number	:	1841157864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYIANNI MATHIS RBT

Provider Business Mailing Address
First Line	:	5029 WEXFORD DR
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-6728
Country	:	US
Telephone Number	:	321-541-1970
Fax Number	:	321-821-1378

Provider Business Practice Location Address
First Line	:	897 YORKTOWNE DR
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-8106
Country	:	US
Telephone Number	:	321-541-1970
Fax Number	:

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

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/10/2026

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Directions to “ NYIANNI MATHIS RBT” Practice Location

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