Provider Demographics
NPI:1386493484
Name:ATTALLAH, JOSEPH ANTHONY S
Entity type:Individual
Prefix:
First Name:JOSEPH ANTHONY
Middle Name:S
Last Name:ATTALLAH
Suffix:
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 1:7524 BRIGHTWATER PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5648
Mailing Address - Country:US
Mailing Address - Phone:321-444-0381
Mailing Address - Fax:
Practice Address - Street 1:7524 BRIGHTWATER PL
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5648
Practice Address - Country:US
Practice Address - Phone:321-444-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-242721106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician