Provider Demographics
NPI:1801037288
Name:BRYNILDSON, KAY DARLENE (EDS, BCBA)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:DARLENE
Last Name:BRYNILDSON
Suffix:
Gender:F
Credentials:EDS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 FOUNTAINHEAD DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4228
Mailing Address - Country:US
Mailing Address - Phone:727-586-5785
Mailing Address - Fax:727-585-4214
Practice Address - Street 1:1158 FOUNTAINHEAD DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4228
Practice Address - Country:US
Practice Address - Phone:727-586-5785
Practice Address - Fax:727-585-4214
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-00-0085103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686320596OtherMEDWAIVER HCBS
FL686320598OtherMEDWAIVER HCBS/FSL