Provider Demographics
NPI:1770254039
Name:DOMBROSKI, JESSEY ROBERT
Entity Type:Individual
Prefix:
First Name:JESSEY
Middle Name:ROBERT
Last Name:DOMBROSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-5342
Mailing Address - Country:US
Mailing Address - Phone:863-214-1720
Mailing Address - Fax:
Practice Address - Street 1:936 SHAMROCK DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-5342
Practice Address - Country:US
Practice Address - Phone:863-214-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician