Healthcare Provider Details

I. General information

NPI: 1871186189
Provider Name (Legal Business Name): BRANDYN NICOLE CARRAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRANDYN NICOLE VOGT

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13574 VILLAGE PARK DR STE 205
ORLANDO FL
32837-7694
US

IV. Provider business mailing address

13574 VILLAGE PARK DR STE 205
ORLANDO FL
32837-7694
US

V. Phone/Fax

Practice location:
  • Phone: 407-990-2847
  • Fax:
Mailing address:
  • Phone: 407-990-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI4710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: