Healthcare Provider Details

I. General information

NPI: 1841148293
Provider Name (Legal Business Name): RADIANT PREP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W 39TH ST APT 18E
NEW YORK NY
10018-1790
US

IV. Provider business mailing address

330 W 39TH ST APT 18E
NEW YORK NY
10018-1790
US

V. Phone/Fax

Practice location:
  • Phone: 929-503-5398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BRICE MESSAVUSSU
Title or Position: OWNER
Credential:
Phone: 929-503-5398