Provider Demographics
NPI:1790136604
Name:TEJERA, BRIANNA
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:TEJERA
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 1:330 W 45TH ST
Mailing Address - Street 2:APT LM
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-3853
Mailing Address - Country:US
Mailing Address - Phone:212-321-0652
Mailing Address - Fax:
Practice Address - Street 1:330 W 45TH ST
Practice Address - Street 2:APT LM
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-3853
Practice Address - Country:US
Practice Address - Phone:212-321-0652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist