MEDICARE: BRANDY MCCULLOUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	401659580614	OH

General Provider Information

NPI Number	:	1013809433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY MCCULLOUGH

Provider Business Mailing Address
First Line	:	1047 OXFORD RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-1825
Country	:	US
Telephone Number	:	216-600-7201
Fax Number	:

Provider Business Practice Location Address
First Line	:	1047 OXFORD RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-1825
Country	:	US
Telephone Number	:	216-600-7201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	07/18/2025

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