Provider Demographics
NPI:1346332616
Name:SMEDLEY, BRYAN D (HEALTH SERVICE TECH)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:SMEDLEY
Suffix:
Gender:M
Credentials:HEALTH SERVICE TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 CRYSTAL AVE UNIT 14
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6541
Mailing Address - Country:US
Mailing Address - Phone:425-249-4145
Mailing Address - Fax:
Practice Address - Street 1:15 MOHEGAN AVE
Practice Address - Street 2:MEDICAL CLINIC
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-8100
Practice Address - Country:US
Practice Address - Phone:860-444-8402
Practice Address - Fax:860-444-8412
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other