Healthcare Provider Details

I. General information

NPI: 1235633686
Provider Name (Legal Business Name): ASHLEY SUE-ANN BRYAN B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N GOLDENROD RD, SUITE 2
ORLANDO FL
32807-3280
US

IV. Provider business mailing address

1601 N GOLDENROD RD STE 2
ORLANDO FL
32807-8308
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-7811
  • Fax:
Mailing address:
  • Phone: 407-704-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: