Provider Demographics
NPI:1740680214
Name:MAYSONET, JOHANEL (MED)
Entity type:Individual
Prefix:
First Name:JOHANEL
Middle Name:
Last Name:MAYSONET
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 ROYAL FERN PL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-2296
Mailing Address - Country:US
Mailing Address - Phone:321-746-0182
Mailing Address - Fax:
Practice Address - Street 1:12025 FOUNTAINBROOK BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7046
Practice Address - Country:US
Practice Address - Phone:407-928-1372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician