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General NPI Number Information
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NPI Number | 1871062869
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Entity Type | Individual
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Provider Name | BRITTANY BANDY
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Gender | Female
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 490 CENTRE LAKE DR NE STE 200B
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City | PALM BAY
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State | FL
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Zip | 32907-1189
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Country | US
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Telephone | 321-784-8211
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Fax | 321-394-9425
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Provider Business Mailing Address
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Address Line | 490 CENTRE LAKE DR NE STE 200B
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City | PALM BAY
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State | FL
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Zip | 32907-1189
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Country | US
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Telephone | 321-784-8211
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9115766
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 310589
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License Number State | LA
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