Healthcare Provider Details

I. General information

NPI: 1861837361
Provider Name (Legal Business Name): BRANDON JAMES BROWNELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 UNION RD
WEST SENECA NY
14224-3445
US

IV. Provider business mailing address

3719 UNION ROAD SUITE 218
CHEEKTOWAGA NY
14225-4251
US

V. Phone/Fax

Practice location:
  • Phone: 716-712-0851
  • Fax:
Mailing address:
  • Phone: 716-206-1555
  • Fax: 716-651-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number287359
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number287359
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: