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NPI Code Detail

MEDICARE: STEPHANIE LEE BRANDAO DMD

MEDICARE: STEPHANIE LEE BRANDAO DMD
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
1122300000XDentistDE60972402WA
2122300000XDentistDN26711FL

General Provider Information

NPI Number : 1497300305
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE LEE BRANDAO DMD
Provider Business Mailing Address
First Line : PO BOX 919771
Second Line :
City : ORLANDO
State : FL
Zip : 32891-0001
Country : US
Telephone Number : 239-278-3600
Fax Number : 239-479-5202
Provider Business Practice Location Address
First Line : 19701 S TAMIAMI TRL
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-4818
Country : US
Telephone Number : 239-314-1630
Fax Number : 239-425-6401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2019
Last Update Date : 05/09/2022

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Directions to “ STEPHANIE LEE BRANDAO DMD” Practice Location

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