MEDICARE: BRANDON GILLIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PS018490	PA

General Provider Information

NPI Number	:	1427545904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON GILLIE

Provider Business Mailing Address
First Line	:	630 PEACHDALE LN
Second Line	:
City	:	DUNCANSVILLE
State	:	PA
Zip	:	16635-7515
Country	:	US
Telephone Number	:	724-689-4850
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 S MONTGOMERY ST STE 2B
Second Line	:
City	:	HOLLIDAYSBURG
State	:	PA
Zip	:	16648-1737
Country	:	US
Telephone Number	:	814-379-6890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	11/04/2025

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Directions to “ BRANDON GILLIE ” Practice Location

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