Provider Demographics
NPI:1790657625
Name:BASDEO, JAQUELIN GIULIANA
Entity type:Individual
Prefix:
First Name:JAQUELIN
Middle Name:GIULIANA
Last Name:BASDEO
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 1:7117 MAYSVILLE CT
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-8236
Mailing Address - Country:US
Mailing Address - Phone:813-944-0332
Mailing Address - Fax:
Practice Address - Street 1:7117 MAYSVILLE CT
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-8236
Practice Address - Country:US
Practice Address - Phone:813-944-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-472156106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty