Healthcare Provider Details

I. General information

NPI: 1326629783
Provider Name (Legal Business Name): BRANDY MACLEAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9723 NORTHEAST PKWY STE 100
MATTHEWS NC
28105-9719
US

IV. Provider business mailing address

9723 NORTHEAST PKWY STE 100
MATTHEWS NC
28105-9719
US

V. Phone/Fax

Practice location:
  • Phone: 980-262-3007
  • Fax: 980-262-3528
Mailing address:
  • Phone: 980-262-3007
  • Fax: 980-262-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16447
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: