Provider Demographics
NPI:1942937354
Name:BRYANT, ERNESTINE SHANIKA (PBT(ASCP)CM)
Entity Type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:SHANIKA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PBT(ASCP)CM
Other - Prefix:
Other - First Name:PROFESSIONAL
Other - Middle Name:
Other - Last Name:PRICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:372 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1455
Mailing Address - Country:US
Mailing Address - Phone:919-338-7860
Mailing Address - Fax:
Practice Address - Street 1:372 MAPLE RD
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1455
Practice Address - Country:US
Practice Address - Phone:919-338-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY49193246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy