Provider Demographics
NPI:1336656586
Name:GIGLIOTTI, BRYAN (MS CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:GIGLIOTTI
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6396 31ST AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-3235
Mailing Address - Country:US
Mailing Address - Phone:727-542-5636
Mailing Address - Fax:
Practice Address - Street 1:6396 31ST AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-3235
Practice Address - Country:US
Practice Address - Phone:727-542-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist