Provider Demographics
NPI:1376146852
Name:BRYANT, SEFTON M
Entity Type:Individual
Prefix:
First Name:SEFTON
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8677 FOXWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1773
Mailing Address - Country:US
Mailing Address - Phone:216-533-9155
Mailing Address - Fax:
Practice Address - Street 1:8677 FOXWOOD CIR
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1773
Practice Address - Country:US
Practice Address - Phone:216-533-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT719613343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)