Basic Information
| Provider Information | |||||||||
| NPI: | 1942560800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAYS | ||||||||
| FirstName: | BREYANNA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6451 N FEDERAL HWY STE 800 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333081409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005865022 | ||||||||
| FaxNumber: | 8159337090 | ||||||||
| Practice Location | |||||||||
| Address1: | 21141 GOVERNORS HWY STE 114 | ||||||||
| Address2: | |||||||||
| City: | MATTESON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604433818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083208480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2012 | ||||||||
| LastUpdateDate: | 09/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 036140626 | IL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.