Healthcare Provider Details

I. General information

NPI: 1083035885
Provider Name (Legal Business Name): BRYAN SALEEBA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 MIDDLE ST
FALL RIVER MA
02721
US

IV. Provider business mailing address

795 MIDDLE ST
FALL RIVER MA
02721-1733
US

V. Phone/Fax

Practice location:
  • Phone: 508-674-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201394073NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2272854
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: