=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992327324
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW TAYLOR BRYANT AU.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2020
-----------------------------------------------------
Last Update Date | 05/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 LYNNHAVEN PKWY STE A
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-7411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-357-9751
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1125 LOVING RD
-----------------------------------------------------
City | ZION CROSSROADS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22942-6846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 2201001771
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------