Healthcare Provider Details

I. General information

NPI: 1841110327
Provider Name (Legal Business Name): BRIANNA CASSIDY MADDOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 SNYDER AVE
BROOKLYN NY
11203-4110
US

IV. Provider business mailing address

4316 SNYDER AVE
BROOKLYN NY
11203-4110
US

V. Phone/Fax

Practice location:
  • Phone: 229-564-1368
  • Fax:
Mailing address:
  • Phone: 229-564-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: