Healthcare Provider Details

I. General information

NPI: 1316933070
Provider Name (Legal Business Name): CAROLINA BRANDAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 KENTSHIRE BLVD
OCOEE FL
34761-4610
US

IV. Provider business mailing address

3400 KENTSHIRE BLVD
OCOEE FL
34761-4610
US

V. Phone/Fax

Practice location:
  • Phone: 305-505-8661
  • Fax:
Mailing address:
  • Phone: 305-505-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME86669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: