MEDICARE: BRANDON SMITH

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	172A00000X	Driver		VA

General Provider Information

NPI Number	:	1427925478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON SMITH

Provider Business Mailing Address
First Line	:	2715 ROANOKE AVE
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23607-4237
Country	:	US
Telephone Number	:	757-256-7455
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 ROANOKE AVE
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23607-4237
Country	:	US
Telephone Number	:	757-256-7455
Fax Number	:

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

Provider Enumeration Date	:	10/22/2025
Last Update Date	:	01/05/2026

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Directions to “ BRANDON SMITH ” Practice Location

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