Healthcare Provider Details

I. General information

NPI: 1285131482
Provider Name (Legal Business Name): BRANDON M NUDELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 148TH AVE NE FL B1
BELLEVUE WA
98007-3120
US

IV. Provider business mailing address

601 BROADWAY STE 700
SEATTLE WA
98122-5330
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA164777
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD61551110
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: