MEDICARE: JASMINE LAASIA BRYANT

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

General Provider Information

NPI Number	:	1932968807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE LAASIA BRYANT

Provider Business Mailing Address
First Line	:	PO BOX 360595
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-6595
Country	:	US
Telephone Number	:	718-215-5311
Fax Number	:	718-865-5165

Provider Business Practice Location Address
First Line	:	2186 NORTH NJ 27
Second Line	:	1A
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-6595
Country	:	US
Telephone Number	:	718-215-5311
Fax Number	:	718-865-5165

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

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	03/14/2024

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Directions to “ JASMINE LAASIA BRYANT ” Practice Location

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