Provider Demographics
NPI:1205410628
Name:MUECKAY, BRIANNA V
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:V
Last Name:MUECKAY
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 1:1800 PEMBROOK DR STE 195
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6300
Mailing Address - Country:US
Mailing Address - Phone:407-212-1199
Mailing Address - Fax:407-386-7037
Practice Address - Street 1:1800 PEMBROOK DR STE 195
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6300
Practice Address - Country:US
Practice Address - Phone:407-212-1199
Practice Address - Fax:407-386-7037
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician