Provider Demographics
NPI:1942560800
Name:GRAYS, BREYANNA N (MD)
Entity Type:Individual
Prefix:
First Name:BREYANNA
Middle Name:N
Last Name:GRAYS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 N FEDERAL HWY STE 800
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1409
Mailing Address - Country:US
Mailing Address - Phone:800-586-5022
Mailing Address - Fax:815-933-7090
Practice Address - Street 1:21141 GOVERNORS HWY STE 114
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3818
Practice Address - Country:US
Practice Address - Phone:708-320-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361406262084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology