Provider Demographics
NPI:1184945636
Name:MEYER, BRYANT ALEXANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:ALEXANDRA
Last Name:MEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LONG WHARF DR STE 212
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5593
Mailing Address - Country:US
Mailing Address - Phone:203-624-4208
Mailing Address - Fax:203-624-4301
Practice Address - Street 1:1 LONG WHARF DR STE 212
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5593
Practice Address - Country:US
Practice Address - Phone:203-624-4208
Practice Address - Fax:203-624-4301
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9105126363AM0700X
CT3106363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY04YBOtherBCBS OF FLORIDA
FLDL857ZMedicare PIN