Provider Demographics
NPI:1568190569
Name:ANTUZZI, BREEANNA MAYO
Entity Type:Individual
Prefix:MRS
First Name:BREEANNA
Middle Name:MAYO
Last Name:ANTUZZI
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 1:20410 BRIDGE MANOR LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4052
Mailing Address - Country:US
Mailing Address - Phone:562-447-6050
Mailing Address - Fax:
Practice Address - Street 1:20410 BRIDGE MANOR LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-4052
Practice Address - Country:US
Practice Address - Phone:562-447-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist