Healthcare Provider Details

I. General information

NPI: 1285567289
Provider Name (Legal Business Name): DR. BLAKE BRADLEY HAMEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 BELL SHOALS RD
BRANDON FL
33511-9014
US

IV. Provider business mailing address

1168 BELL SHOALS RD
BRANDON FL
33511-9014
US

V. Phone/Fax

Practice location:
  • Phone: 813-822-3058
  • Fax:
Mailing address:
  • Phone: 813-822-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: