Healthcare Provider Details

I. General information

NPI: 1063758266
Provider Name (Legal Business Name): BRANDY'S SHOES USA , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 N FEDERAL HWY
POMPANO BEACH 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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPED159
License Number StateFL

VIII. Authorized Official

Name: MOHAMMED ASAM ASAD
Title or Position: PRESIDENT
Credential: M.D
Phone: 954-943-9667