MEDICARE: JEANETTE PRZYBYSZEWSKI BCBA

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	103K00000X	Behavior Analyst	1-20-42063	FL
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1962902700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE PRZYBYSZEWSKI BCBA

Provider Business Mailing Address
First Line	:	4553 GRAND BLVD STE 206
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-5157
Country	:	US
Telephone Number	:	727-534-3234
Fax Number	:

Provider Business Practice Location Address
First Line	:	4553 GRAND BLVD STE 206
Second Line	:
City	:	NEW PRT RCHY
State	:	FL
Zip	:	34652-5157
Country	:	US
Telephone Number	:	727-534-3234
Fax Number	:	727-255-5151

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

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	09/12/2025

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