Healthcare Provider Details

I. General information

NPI: 1356288039
Provider Name (Legal Business Name): DIAMOND TAKEYA BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 21892
HILTON HEAD SC
29925-1892
US

IV. Provider business mailing address

225 SHADOWBROOK LN UNIT 205
RIDGELAND SC
29936-3238
US

V. Phone/Fax

Practice location:
  • Phone: 843-505-2952
  • Fax:
Mailing address:
  • Phone: 843-505-2952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2109236
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: