Provider Demographics
NPI:1073151783
Name:ROBINSON, DEVON JEFFREY I
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:JEFFREY
Last Name:ROBINSON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 PICCADILLY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3828
Mailing Address - Country:US
Mailing Address - Phone:386-453-0007
Mailing Address - Fax:
Practice Address - Street 1:1628 PICCADILLY DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-3828
Practice Address - Country:US
Practice Address - Phone:386-453-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-105227106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician