Kelly D Brzak

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

2400 S Ridgewood Ave Ste 17
South Daytona, FL 32119-3073

Phone

(386) 690-0893

NPI assigned

Sep 1, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1386191823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 N PENINSULA DR",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321183748",
            "telephone_number": "386-444-5742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 S RIDGEWOOD AVE STE 17",
            "city": "SOUTH DAYTONA",
            "state": "FL",
            "postal_code": "321193073",
            "telephone_number": "386-690-0893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRZAK",
        "first_name": "KELLY",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-01",
        "last_updated": "2021-08-19",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in South Daytona, FL
• Providers in South Daytona, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.