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General NPI Number Information
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NPI Number | 1609102276
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Entity Type | Individual
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Provider Name | BRANDON EDWARD MOONEY MT, PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE DESK Q10-1
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-444-3958
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Fax | 216-444-7031
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Provider Business Mailing Address
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Address Line | 9500 EUCLID AVE DESK Q10-1
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-444-3958
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Fax | 216-444-7031
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.001593
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License Number State | OH
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