Provider Demographics
NPI:1922529817
Name:JEUDY, EMMANUELLE CHRISTIE
Entity Type:Individual
Prefix:
First Name:EMMANUELLE
Middle Name:CHRISTIE
Last Name:JEUDY
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 1:12340 SW 185TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3108
Mailing Address - Country:US
Mailing Address - Phone:662-371-2148
Mailing Address - Fax:
Practice Address - Street 1:18001 OLD CUTLER RD STE 649
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6442
Practice Address - Country:US
Practice Address - Phone:305-812-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid