Provider Demographics
NPI:1629726005
Name:DESDIN, JASSY RASHELL
Entity Type:Individual
Prefix:
First Name:JASSY
Middle Name:RASHELL
Last Name:DESDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 SW 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2635
Mailing Address - Country:US
Mailing Address - Phone:305-879-4166
Mailing Address - Fax:
Practice Address - Street 1:2430 SW 99TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2635
Practice Address - Country:US
Practice Address - Phone:305-879-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician