MEDICARE: BRIYANNA DENISE GARDNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		VA

General Provider Information

NPI Number	:	1255285722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIYANNA DENISE GARDNER

Provider Business Mailing Address
First Line	:	293 INDEPENDENCE BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5466
Country	:	US
Telephone Number	:	757-785-3338
Fax Number	:

Provider Business Practice Location Address
First Line	:	293 INDEPENDENCE BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5466
Country	:	US
Telephone Number	:	757-785-3338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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