Provider Demographics
NPI:1932724366
Name:BRYANT, TODD C (FNP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:BRYANT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5856 SCENIC AVE
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-3012
Mailing Address - Country:US
Mailing Address - Phone:315-963-4133
Mailing Address - Fax:
Practice Address - Street 1:5856 SCENIC AVE
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-3012
Practice Address - Country:US
Practice Address - Phone:315-963-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345944-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily