Healthcare Provider Details

I. General information

NPI: 1982275657
Provider Name (Legal Business Name): ALIESHA BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HENRY HUDSON PKWY APT 2F
BRONX NY
10463-4738
US

IV. Provider business mailing address

2700 HENRY HUDSON PKWY APT 2F
BRONX NY
10463-4738
US

V. Phone/Fax

Practice location:
  • Phone: 347-409-9457
  • Fax:
Mailing address:
  • Phone: 347-409-9457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: