Individual
AJAHLEI BROADUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1128 BEVILLE RD, DAYTONA BEACH, FL 32114-5747
(386) 267-3161
Mailing address
175 MIDDLE ST UNIT 1201, LAKE MARY, FL 32746-3625
(866) 610-0580
(866) 610-0580
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009093700
—
FL
Enumeration date
03/20/2018
Last updated
03/20/2018
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