Healthcare Provider Details

I. General information

NPI: 1285577189
Provider Name (Legal Business Name): BRYESHIA T LIONHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CARLETON ST APT 405
PROVIDENCE RI
02908-5251
US

IV. Provider business mailing address

211 CARLETON ST APT 405
PROVIDENCE RI
02908-5251
US

V. Phone/Fax

Practice location:
  • Phone: 401-382-9968
  • Fax:
Mailing address:
  • Phone: 401-382-9968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13615052
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: