Provider Demographics
NPI:1295315679
Name:BRYANT, SANDY LEE (CNA)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:LEE
Last Name:BRYANT
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4518 ALLIGATOR FLAG CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8199
Mailing Address - Country:US
Mailing Address - Phone:615-648-1278
Mailing Address - Fax:
Practice Address - Street 1:4518 ALLIGATOR FLAG CIR
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8199
Practice Address - Country:US
Practice Address - Phone:615-648-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL288528376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide