Healthcare Provider Details

I. General information

NPI: 1558245092
Provider Name (Legal Business Name): BRANDON MICHEAL VACCHIO PRSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 N MARSHAM ST
ROMNEY WV
26757-1623
US

IV. Provider business mailing address

PO BOX 299
ROMNEY WV
26757-0299
US

V. Phone/Fax

Practice location:
  • Phone: 304-359-2185
  • Fax:
Mailing address:
  • Phone: 304-359-2185
  • Fax: 304-359-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number24-913
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: