Provider Demographics
NPI:1861699886
Name:BRYANT, SHARON MATLOCK
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:MATLOCK
Last Name:BRYANT
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 1:1036 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-8807
Mailing Address - Country:US
Mailing Address - Phone:919-767-9723
Mailing Address - Fax:919-768-7327
Practice Address - Street 1:1036 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-8807
Practice Address - Country:US
Practice Address - Phone:919-767-9723
Practice Address - Fax:919-768-7327
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies