Healthcare Provider Details

I. General information

NPI: 1497928394
Provider Name (Legal Business Name): BRENDAN MICHAEL PRENDERGAST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 N WICKHAM RD
MELBOURNE FL
32940-2239
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-253-4673
  • Fax: 321-253-4338
Mailing address:
  • Phone: 321-253-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME115355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: