Provider Demographics
NPI:1407449200
Name:BROWN, KYANNA
Entity Type:Individual
Prefix:
First Name:KYANNA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 PINE PARK TRL APT 2535
Mailing Address - Street 2:
Mailing Address - City:UNION PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1775 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5067
Practice Address - Country:US
Practice Address - Phone:407-574-7614
Practice Address - Fax:321-332-7799
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician