Provider Demographics
NPI:1982275657
Name:BRYAN, ALIESHA
Entity Type:Individual
Prefix:
First Name:ALIESHA
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 HENRY HUDSON PKWY APT 2F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4738
Mailing Address - Country:US
Mailing Address - Phone:347-409-9457
Mailing Address - Fax:
Practice Address - Street 1:2700 HENRY HUDSON PKWY APT 2F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4738
Practice Address - Country:US
Practice Address - Phone:347-409-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist