Provider Demographics
NPI:1689212540
Name:CULLUM, BRIANNAH MICHELLE
Entity Type:Individual
Prefix:MS
First Name:BRIANNAH
Middle Name:MICHELLE
Last Name:CULLUM
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 1:10 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6610
Mailing Address - Country:US
Mailing Address - Phone:516-467-9388
Mailing Address - Fax:
Practice Address - Street 1:10 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-6610
Practice Address - Country:US
Practice Address - Phone:516-467-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist