Healthcare Provider Details

I. General information

NPI: 1619807096
Provider Name (Legal Business Name): BRYON BELLAMY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 GLENWOOD AVE STE 200
RALEIGH NC
27612-3857
US

IV. Provider business mailing address

4818 SWANNS MILL DR
DURHAM NC
27704-1492
US

V. Phone/Fax

Practice location:
  • Phone: 910-257-3755
  • Fax:
Mailing address:
  • Phone: 910-257-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number20261144701
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: