=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336902204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDY NUMARIA SHAMI COLBERT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2024
-----------------------------------------------------
Last Update Date | 02/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37818 COLINA DR
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33523-6029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-479-8398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2341
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33526-2341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-479-8398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number | 239876
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------