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NPI Code Detail

MEDICARE: WYSLANDIE BRIANNA JEAN BA

MEDICARE: WYSLANDIE BRIANNA JEAN BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorMA

General Provider Information

NPI Number : 1063343796
Entity Type Code : Individual
Provider Name (Legal Business Name) : WYSLANDIE BRIANNA JEAN BA
Provider Business Mailing Address
First Line : 5 OPTICAL DR
Second Line :
City : SOUTHBRIDGE
State : MA
Zip : 01550-2559
Country : US
Telephone Number : 508-765-9101
Fax Number :
Provider Business Practice Location Address
First Line : 5 OPTICAL DR
Second Line :
City : SOUTHBRIDGE
State : MA
Zip : 01550-2559
Country : US
Telephone Number : 508-765-9101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2026
Last Update Date : 06/10/2026

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Directions to “ WYSLANDIE BRIANNA JEAN BA” Practice Location

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