Healthcare Provider Details

I. General information

NPI: 1346702537
Provider Name (Legal Business Name): MACEY SUE BRANDEBERRY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E POST RD
WHITE PLAINS NY
10601-4699
US

IV. Provider business mailing address

5347 E SHORE DR NW
CANTON OH
44718-1658
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-0600
  • Fax:
Mailing address:
  • Phone: 419-619-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34.017485
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: