Provider Demographics
NPI:1114419264
Name:NEALEY, BRITON WILLIAM (RDMS, RDCS, RVT)
Entity Type:Individual
Prefix:
First Name:BRITON
Middle Name:WILLIAM
Last Name:NEALEY
Suffix:
Gender:M
Credentials:RDMS, RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 W LUMSDEN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8820
Mailing Address - Country:US
Mailing Address - Phone:813-549-7820
Mailing Address - Fax:813-549-7823
Practice Address - Street 1:1971 W LUMSDEN RD STE 106
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8820
Practice Address - Country:US
Practice Address - Phone:813-549-7820
Practice Address - Fax:813-549-7823
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1291032471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography