Provider Demographics
NPI:1194512103
Name:BRYANT, ANGELIQUE ROSITA
Entity type:Individual
Prefix:MS
First Name:ANGELIQUE
Middle Name:ROSITA
Last Name:BRYANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 ASH CIR APT 202
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6534
Mailing Address - Country:US
Mailing Address - Phone:407-274-0172
Mailing Address - Fax:407-274-0172
Practice Address - Street 1:6973 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6713
Practice Address - Country:US
Practice Address - Phone:888-745-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty