Provider Demographics
NPI:1003153917
Name:BRANDOW, VALERIE (MA, TVI)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:
Last Name:BRANDOW
Suffix:
Gender:F
Credentials:MA, TVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8581
Mailing Address - Country:US
Mailing Address - Phone:631-744-3205
Mailing Address - Fax:
Practice Address - Street 1:4 WALNUT RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8581
Practice Address - Country:US
Practice Address - Phone:631-744-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY945520991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist