Healthcare Provider Details

I. General information

NPI: 1942136643
Provider Name (Legal Business Name): TANAYA BRANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OAKLAND PARK BLVD STE 302B
SUNRISE FL
33351-6743
US

IV. Provider business mailing address

501 NW 7TH AVE APT 470
FORT LAUDERDALE FL
33311-9184
US

V. Phone/Fax

Practice location:
  • Phone: 305-317-4206
  • Fax:
Mailing address:
  • Phone: 214-206-7609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: