Provider Demographics
NPI:1548086028
Name:TORO RODRIGUEZ, JAILYN ELAINE
Entity type:Individual
Prefix:
First Name:JAILYN
Middle Name:ELAINE
Last Name:TORO RODRIGUEZ
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 1:1145 SHADY OAK LN
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2546
Mailing Address - Country:US
Mailing Address - Phone:386-837-5627
Mailing Address - Fax:
Practice Address - Street 1:1530 TEDDINGTON ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0872
Practice Address - Country:US
Practice Address - Phone:407-221-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician