Healthcare Provider Details

I. General information

NPI: 1235079005
Provider Name (Legal Business Name): MR. BRYCE ALLEN DENMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W TRADE ST
CHARLOTTE NC
28202-1143
US

IV. Provider business mailing address

945 N CENTRAL AVE
WOODMERE NY
11598-1604
US

V. Phone/Fax

Practice location:
  • Phone: 704-561-1143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: