Provider Demographics
NPI:1386201630
Name:SEALS, BRYAN J (HAD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:J
Last Name:SEALS
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 CLEARVISTA PKWY STE 3A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1429
Mailing Address - Country:US
Mailing Address - Phone:317-578-2300
Mailing Address - Fax:
Practice Address - Street 1:8202 CLEARVISTA PKWY STE 3A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1429
Practice Address - Country:US
Practice Address - Phone:317-578-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001525A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist