Individual
JAMILA NICOLE H MYSOREWALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1651 OLD MEADOW RD, SUITE 600, MC LEAN, VA 22102-4311
(305) 926-3811
Mailing address
10560 SW 139TH ST, MIAMI, FL 33176-6640
(305) 926-3811
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133000674
VA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/27/2013
Last updated
01/01/2019
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