Provider Demographics
NPI:1679380182
Name:BRAY, KEIAJAH VICTORIA
Entity type:Individual
Prefix:
First Name:KEIAJAH
Middle Name:VICTORIA
Last Name:BRAY
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 1:980 N 66TH TER APT 2
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5773
Mailing Address - Country:US
Mailing Address - Phone:954-994-7821
Mailing Address - Fax:
Practice Address - Street 1:980 N 66TH TER APT 2
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5773
Practice Address - Country:US
Practice Address - Phone:954-994-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician