Provider Demographics
NPI:1104575935
Name:JEFFERY, TONI J
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:J
Last Name:JEFFERY
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 1:104 CAROLINA LAKE DR APT 208
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-7491
Mailing Address - Country:US
Mailing Address - Phone:386-675-3703
Mailing Address - Fax:
Practice Address - Street 1:104 CAROLINA LAKE DR APT 208
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-7491
Practice Address - Country:US
Practice Address - Phone:386-681-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-166948106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician