Healthcare Provider Details

I. General information

NPI: 1417481409
Provider Name (Legal Business Name): HEATHER BRANDT D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

4890 PARAMOUNT CT
NORTH CANTON OH
44720-1277
US

V. Phone/Fax

Practice location:
  • Phone: 330-962-4266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.016274
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number34.016274
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: