Jacob Matheny Desuyo, DSL, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

125792235 Issued in FL

Practice address

204 Gallicia Ave
Saint Augustine, FL 32086-8838

Phone

(904) 401-7144

NPI assigned

Mar 13, 2025

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1741824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1104626886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 GALLICIA AVE",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320868838",
            "telephone_number": "904-401-7144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 GALLICIA AVE",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320868838",
            "telephone_number": "904-401-7144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESUYO",
        "first_name": "JACOB",
        "middle_name": "MATHENY",
        "credential": "DSL, BCBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-03-13",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "125792235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Desai
• Parth Milan Desai, DO
• Vinod Deshmukh, M.D., PH.D.
• Rodnika Desmore
• Godlive Desravines, APRN
• Tara Lovett Dettra, L.M., C.P.M.
• Michael David Deveau, MD
• Jennifer Deverin
• Valerie Catherine Deville, LMHC
• John Devlin

• Behavior Analyst in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.