Healthcare Provider Details

I. General information

NPI: 1821934571
Provider Name (Legal Business Name): KATARIIAH A'SHONTAE BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 LAKELAND HILLS BLVD STE 204
LAKELAND FL
33805-3208
US

IV. Provider business mailing address

1859 GRAND BAY CIR APT 202
LAKELAND FL
33810-1918
US

V. Phone/Fax

Practice location:
  • Phone: 863-337-5643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5038
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: