=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356407068
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EWA B BRANDYS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 09/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13535 NEMOURS PKWY
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32827-7402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-567-4000
-----------------------------------------------------
Fax | 407-567-5924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 191 PROVIDER ENROLLMENT DEPT
-----------------------------------------------------
City | ROCKLAND
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19732-0191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-651-6212
-----------------------------------------------------
Fax | 302-651-4945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P0010X
-----------------------------------------------------
Taxonomy Name | Pediatric Rehabilitation Medicine Physician
-----------------------------------------------------
License Number | MD420876
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081P0010X
-----------------------------------------------------
Taxonomy Name | Pediatric Rehabilitation Medicine Physician
-----------------------------------------------------
License Number | 44689
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2081P0010X
-----------------------------------------------------
Taxonomy Name | Pediatric Rehabilitation Medicine Physician
-----------------------------------------------------
License Number | D0060601
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2081P0010X
-----------------------------------------------------
Taxonomy Name | Pediatric Rehabilitation Medicine Physician
-----------------------------------------------------
License Number | ME124623
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------