| Doctor Name: | BRYANT DOMEMECH |
| NPI Number: | 1477670867 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | ARNP2728722 |
| Business Practice Address: | 237 Fernwood Blvd Fern Park, FL - 327302116 |
| Business Phone Number: | 4078312411 |
| Business Fax Number: | 4078310195 |
| Mailing Address: | 1214 Foxtree Trl, APOPKA |
| State: | FL |
| Postal Code: | 327123014 |
| Phone Number: | 4078147485 |
| Fax Number: | |
| NPI Enumeration Date: | 03/23/2007 |
| NPI Last Update Date: | 08/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | ARNP2728722 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |