Provider Demographics
NPI:1861010027
Name:MASOTTI, JAIME OSTENDORF
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:OSTENDORF
Last Name:MASOTTI
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 1:3058 CYPRESS CREEK DR N
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3018
Mailing Address - Country:US
Mailing Address - Phone:404-769-3229
Mailing Address - Fax:
Practice Address - Street 1:3058 CYPRESS CREEK DR N
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3018
Practice Address - Country:US
Practice Address - Phone:404-769-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1708101YM0800X
NC7192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health