Provider Demographics
NPI:1033963236
Name:BRYANT, SHAWNTAE MONIQUE
Entity Type:Individual
Prefix:
First Name:SHAWNTAE
Middle Name:MONIQUE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27600 CHARDON RD APT 366
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2776
Mailing Address - Country:US
Mailing Address - Phone:440-223-8453
Mailing Address - Fax:
Practice Address - Street 1:35400 EUCLID AVE APT A106
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-4520
Practice Address - Country:US
Practice Address - Phone:440-667-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion