| Raeon Bryan | |
|
309 Providence Rd Brandon FL 33511-4761 | |
| (727) 564-0524 | |
| Not Available |
| Full Name | Raeon Bryan |
|---|---|
| Speciality | Behavior Technician |
| Location | 309 Providence Rd, Brandon, Florida |
| Authorized Official Name and Position | Audrey Watson (CEO) |
| Authorized Official Contact | 8134388276 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Raeon Bryan 309 Providence Rd Brandon FL 33511-4761 Ph: () - | Raeon Bryan 309 Providence Rd Brandon FL 33511-4761 Ph: (727) 564-0524 |
| NPI Number | 1881135580 |
|---|---|
| Provider Enumeration Date | 03/14/2017 |
| Last Update Date | 03/14/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881135580 | NPI | - | NPPES |
| 018120200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106S00000X | Behavior Technician | 103K00000X (Florida) | Primary |
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