MEDICARE: BRANDON ANDREW RICHARDS

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	175T00000X	Peer Specialist	APS.006572	OH

General Provider Information

NPI Number	:	1942199187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON ANDREW RICHARDS

Provider Business Mailing Address
First Line	:	1404 19TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3502
Country	:	US
Telephone Number	:	234-458-3922
Fax Number	:	234-458-3922

Provider Business Practice Location Address
First Line	:	1404 19TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3502
Country	:	US
Telephone Number	:	234-458-3922
Fax Number	:	234-458-3922

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

Provider Enumeration Date	:	07/01/2025
Last Update Date	:	07/01/2025

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Directions to “ BRANDON ANDREW RICHARDS ” Practice Location

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