Healthcare Provider Details

I. General information

NPI: 1407184450
Provider Name (Legal Business Name): BRANDY'S SHOES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 NORTH FED HWY
POMPANO BCH FL
33062-3705
US

IV. Provider business mailing address

1290 N FEDERAL HWY
POMPANO BEACH FL
33062-3705
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-9667
  • Fax: 954-941-9204
Mailing address:
  • Phone: 954-943-9667
  • Fax: 954-941-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SCOTT PHILIP BRANSDORF
Title or Position: VP
Credential:
Phone: 954-943-9667