Provider Information for 1558038695
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BRANDAIS QUAY GARY
Other Names:Other Name:BRANDAIS SANTIAGOSex: Female
NPI: 1558038695
Last Updated: 2024-06-26
Certification Date: 2024-06-26
Certification Date: 2024-06-26
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1558038695 | ||||||||
| Enumeration Date | 2021-08-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 123 HAMPDEN DR APT J MOUNTVILLE, PA 17554-1800 United States Phone: 717-824-6370 | Fax: | ||||||||
| Primary Practice Address | 123 HAMPDEN DR APT J MOUNTVILLE, PA 17554-1800 United States Phone: 717-824-6370 | Fax: | ||||||||
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