Provider Demographics
NPI:1417200627
Name:BRYANT, ROSELYNDE (NMD)
Entity Type:Individual
Prefix:DR
First Name:ROSELYNDE
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 E BROADWAY RD
Mailing Address - Street 2:1055
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1773
Mailing Address - Country:US
Mailing Address - Phone:504-957-1028
Mailing Address - Fax:
Practice Address - Street 1:812 W WARNER RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2933
Practice Address - Country:US
Practice Address - Phone:480-999-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12-1324175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath