Provider Demographics
NPI:1619602554
Name:FRIERSON, BRYANT TOBY
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:TOBY
Last Name:FRIERSON
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 1:447 BROAD ST APT 4-12
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-5873
Mailing Address - Country:US
Mailing Address - Phone:203-935-6673
Mailing Address - Fax:203-440-4233
Practice Address - Street 1:447 BROAD ST APT 4-12
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5873
Practice Address - Country:US
Practice Address - Phone:203-935-6673
Practice Address - Fax:203-440-4233
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT372500000X, 372600000X, 376J00000X, 374U00000X
3747P1801X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemaker