Healthcare Provider Details

I. General information

NPI: 1154259331
Provider Name (Legal Business Name): BRANDON STAFFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

1220 NEWARK RD
ZANESVILLE OH
43701-2621
US

V. Phone/Fax

Practice location:
  • Phone: 614-884-0641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number483608
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: