Provider Demographics
NPI:1689247884
Name:YOUNG, JAMEELAH A
Entity Type:Individual
Prefix:
First Name:JAMEELAH
Middle Name:A
Last Name:YOUNG
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 1:940 WINDGROVE TRL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5415
Mailing Address - Country:US
Mailing Address - Phone:407-408-3879
Mailing Address - Fax:
Practice Address - Street 1:940 WINDGROVE TRL
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5415
Practice Address - Country:US
Practice Address - Phone:407-408-3879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician