Provider Demographics
NPI:1639053242
Name:RILEY-BRYAN, JALIETH PETA-GAY
Entity type:Individual
Prefix:MRS
First Name:JALIETH
Middle Name:PETA-GAY
Last Name:RILEY-BRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JALIETH
Other - Middle Name:PETA-GAY
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:888 VETERANS HWY STE 310
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:888 VETERANS HWY STE 310
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2940
Practice Address - Country:US
Practice Address - Phone:631-851-9473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist