Healthcare Provider Details

I. General information

NPI: 1609150168
Provider Name (Legal Business Name): BRANDY ELUA SANDE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 07/05/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 MDG, UNIT 3215
APO AE
09094
US

IV. Provider business mailing address

86 MDG, UNIT 3215
APO AE
09094
US

V. Phone/Fax

Practice location:
  • Phone: 31-447-9260
  • Fax:
Mailing address:
  • Phone: 314-479-2609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: