Provider Demographics
NPI:1780187062
Name:DELISMA, JERSLY I
Entity Type:Individual
Prefix:
First Name:JERSLY
Middle Name:
Last Name:DELISMA
Suffix:I
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 1:19511 SW 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4264
Mailing Address - Country:US
Mailing Address - Phone:786-426-7822
Mailing Address - Fax:
Practice Address - Street 1:19511 SW 133RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-4264
Practice Address - Country:US
Practice Address - Phone:786-426-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst