Healthcare Provider Details

I. General information

NPI: 1831663954
Provider Name (Legal Business Name): BRYAN CHARLES DAUNT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21475 RIDGETOP CIR STE 150
STERLING VA
20166-6580
US

IV. Provider business mailing address

21475 RIDGETOP CIR STE 150
STERLING VA
20166-6580
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-5000
  • Fax: 703-444-4999
Mailing address:
  • Phone: 703-444-5000
  • Fax: 703-444-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: