Healthcare Provider Details

I. General information

NPI: 1952211526
Provider Name (Legal Business Name): BRANDON F SALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GYMNASIUM ROAD
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

225 MARK TREE RD
CENTEREACH NY
11720-2202
US

V. Phone/Fax

Practice location:
  • Phone: 631-632-6737
  • Fax:
Mailing address:
  • Phone: 516-253-8680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number500514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: