Healthcare Provider Details

I. General information

NPI: 1760216931
Provider Name (Legal Business Name): MISS BRIANA SURRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 SUNNYSIDE RD STE 102
INDIANAPOLIS IN
46235-8513
US

IV. Provider business mailing address

5625 N SUNNYSIDE RD SUITE 102
INDIANAPOLIS IN
46235-8513
US

V. Phone/Fax

Practice location:
  • Phone: 463-328-8862
  • Fax:
Mailing address:
  • Phone: 463-328-8862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number240179971
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number24-017997-1
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number240179971
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: