Healthcare Provider Details

I. General information

NPI: 1902364524
Provider Name (Legal Business Name): BRANDY SANDFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 WASHINGTON AVE STE 202
SAINT LOUIS MO
63103-1936
US

IV. Provider business mailing address

1409 WASHINGTON AVE STE 202 202
SAINT LOUIS MO
63103-1936
US

V. Phone/Fax

Practice location:
  • Phone: 314-302-2332
  • Fax:
Mailing address:
  • Phone: 314-302-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: