MEDICARE: MICHELE ALEXIS BRANDON DO

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	207RI0200X	Infectious Disease Physician	OS20944	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1629636618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE ALEXIS BRANDON DO

Provider Business Mailing Address
First Line	:	653-1 W 8TH ST
Second Line	:	2ND FL LRC
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-7514
Fax Number	:	904-244-5650

Provider Business Practice Location Address
First Line	:	8613 OLD KINGS RD S STE 602
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4863
Country	:	US
Telephone Number	:	904-493-3390
Fax Number	:	904-493-3395

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

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	01/17/2025

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