Healthcare Provider Details

I. General information

NPI: 1174766620
Provider Name (Legal Business Name): BRANDON L SNEAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6765 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89146
US

IV. Provider business mailing address

6765 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89146-2001
US

V. Phone/Fax

Practice location:
  • Phone: 702-518-5774
  • Fax: 702-852-0890
Mailing address:
  • Phone: 702-518-5774
  • Fax: 702-852-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number15428
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number15428
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number15428
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number15428
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number15428
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: