Provider Demographics
NPI:1669580510
Name:MCLEOD-BRYANT, STEPHEN A (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:MCLEOD-BRYANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 PONCE DE LEON BLVD STE 504
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3035
Mailing Address - Country:US
Mailing Address - Phone:843-532-9403
Mailing Address - Fax:843-604-0372
Practice Address - Street 1:814 PONCE DE LEON BLVD STE 504
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3035
Practice Address - Country:US
Practice Address - Phone:786-734-5912
Practice Address - Fax:843-604-0372
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC139972084P0800X
TN495602084P0800X
FLME1238022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I269634Medicare Oscar/Certification
D09198Medicare UPIN
TN1531887Medicaid