Provider Demographics
NPI:1477670867
Name:SANCHEZ-DOMENECH, BRYANT (NP)
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:SANCHEZ-DOMENECH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 FOXTREE TRL
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3014
Mailing Address - Country:US
Mailing Address - Phone:407-814-7485
Mailing Address - Fax:
Practice Address - Street 1:237 FERNWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2116
Practice Address - Country:US
Practice Address - Phone:407-831-2411
Practice Address - Fax:407-831-0195
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2728722363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768918700Medicaid
FLE3366AMedicare PIN