Provider Demographics
NPI:1710386701
Name:BRYAN-JOSEPH, SHERON
Entity Type:Individual
Prefix:
First Name:SHERON
Middle Name:
Last Name:BRYAN-JOSEPH
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 1:2151 GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3685
Mailing Address - Country:US
Mailing Address - Phone:407-201-8634
Mailing Address - Fax:
Practice Address - Street 1:2151 GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3685
Practice Address - Country:US
Practice Address - Phone:407-201-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12486171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator