Healthcare Provider Details

I. General information

NPI: 1841808516
Provider Name (Legal Business Name): BRIANNA AYALA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 N HARBOR CITY BLVD
MELBOURNE FL
32935-6568
US

IV. Provider business mailing address

12141 LILY MAGNOLIA LN
RIVERVIEW FL
33569-5552
US

V. Phone/Fax

Practice location:
  • Phone: 321-638-6818
  • Fax: 321-616-8126
Mailing address:
  • Phone: 631-885-5119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11014959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: