Healthcare Provider Details

I. General information

NPI: 1235092867
Provider Name (Legal Business Name): BRANDON SIMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 VALLESTON PKWY
TOLEDO OH
43607-1159
US

IV. Provider business mailing address

3440 VALLESTON PKWY
TOLEDO OH
43607-1159
US

V. Phone/Fax

Practice location:
  • Phone: 567-217-9569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRS626729
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: