Healthcare Provider Details

I. General information

NPI: 1730913062
Provider Name (Legal Business Name): MR. TROY ANTHONY BRANDON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 3RD AVE
SEATTLE WA
98121-2385
US

IV. Provider business mailing address

1133 24TH AVE UNIT B710
SEATTLE WA
98122-5252
US

V. Phone/Fax

Practice location:
  • Phone: 206-432-3574
  • Fax:
Mailing address:
  • Phone: 202-677-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: