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General NPI Number Information
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NPI Number | 1467271692
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Entity Type | Organization
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Legal Business Name | DRAGONFLY BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1 11TH AVE STE A2
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City | SHALIMAR
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State | FL
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Zip | 32579-1318
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Country | US
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Telephone | 850-790-9621
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Fax |
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Provider Business Mailing Address
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Address Line | 1 11TH AVE STE A2
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City | SHALIMAR
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State | FL
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Zip | 32579-1318
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Country | US
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Telephone | 575-386-6585
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT/OWNER
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Name | MR. RYAN BRADLEY
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Credential | PA-C, CAQ-PSY
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Telephone | 575-386-6585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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