MEDICARE: BRANDI SHAYE MOORE PA

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	363A00000X	Physician Assistant	3169	SC
2	363A00000X	Physician Assistant	0010-11616	NC

General Provider Information

NPI Number	:	1588122501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI SHAYE MOORE PA

Provider Business Mailing Address
First Line	:	2430 REIDVILLE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 REIDVILLE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3652
Country	:	US
Telephone Number	:	864-516-1783
Fax Number	:

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

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	02/02/2026

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Directions to “ BRANDI SHAYE MOORE PA” Practice Location

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