Healthcare Provider Details

I. General information

NPI: 1053247775
Provider Name (Legal Business Name): BRANDEN DESHAWN BRYANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 CATHERINE AVE
DAYTONA BEACH FL
32117-3389
US

IV. Provider business mailing address

837 CATHERINE AVE
DAYTONA BEACH FL
32117-3389
US

V. Phone/Fax

Practice location:
  • Phone: 334-612-1033
  • Fax: 334-612-1033
Mailing address:
  • Phone: 334-612-1033
  • Fax: 334-612-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberDQ35BH
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: