Provider Demographics
NPI:1548750888
Name:BYRD, JOHN (MA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BYRD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 CARRICK BEND DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2974
Mailing Address - Country:US
Mailing Address - Phone:407-209-5404
Mailing Address - Fax:
Practice Address - Street 1:3870 CARRICK BEND DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2974
Practice Address - Country:US
Practice Address - Phone:407-209-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician