Provider Demographics
NPI:1730841511
Name:DELUISE, BRIANNA M
Entity type:Individual
Prefix:MS
First Name:BRIANNA
Middle Name:M
Last Name:DELUISE
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 1:2892 E 197TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3702
Mailing Address - Country:US
Mailing Address - Phone:347-649-5889
Mailing Address - Fax:
Practice Address - Street 1:2962 HARDING AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3435
Practice Address - Country:US
Practice Address - Phone:347-649-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist