Provider Demographics
NPI:1053695924
Name:SCURTO, JAHNEA
Entity type:Individual
Prefix:MRS
First Name:JAHNEA
Middle Name:
Last Name:SCURTO
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 1:130 DEL MUNDO ST NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1861
Mailing Address - Country:US
Mailing Address - Phone:321-953-1413
Mailing Address - Fax:
Practice Address - Street 1:130 DEL MUNDO ST
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907
Practice Address - Country:US
Practice Address - Phone:321-953-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100012805320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities