Provider Demographics
NPI:1063874790
Name:VARGAS SANCHEZ, JASSELY
Entity type:Individual
Prefix:MS
First Name:JASSELY
Middle Name:
Last Name:VARGAS SANCHEZ
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 1:752 COUNTRY WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4627
Mailing Address - Country:US
Mailing Address - Phone:407-747-6169
Mailing Address - Fax:
Practice Address - Street 1:1601 N GOLDENROD RD STE 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-8308
Practice Address - Country:US
Practice Address - Phone:407-704-7811
Practice Address - Fax:407-382-0658
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care