Provider Demographics
NPI:1093548448
Name:REYNOLDS, BRIAN (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4743
Mailing Address - Country:US
Mailing Address - Phone:919-414-0001
Mailing Address - Fax:
Practice Address - Street 1:1505 WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-4743
Practice Address - Country:US
Practice Address - Phone:919-414-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator