Healthcare Provider Details

I. General information

NPI: 1497321178
Provider Name (Legal Business Name): ANA SOFIA LEAL BRAMASCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date: 11/25/2022
Reactivation Date: 08/16/2023

III. Provider practice location address

1818 CAREW ST STE 260
FORT WAYNE IN
46805-4792
US

IV. Provider business mailing address

760 BROADWAY
BROOKLYN NY
11206-5317
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-8820
  • Fax: 260-266-8829
Mailing address:
  • Phone: 718-963-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01099159A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: