Provider Demographics
NPI:1346504347
Name:BRABHAM, AYANNA (MSED)
Entity Type:Individual
Prefix:MS
First Name:AYANNA
Middle Name:
Last Name:BRABHAM
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19109 120TH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3618
Mailing Address - Country:US
Mailing Address - Phone:718-341-8771
Mailing Address - Fax:
Practice Address - Street 1:19109 120TH RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3618
Practice Address - Country:US
Practice Address - Phone:718-341-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1851764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist