Provider Demographics
NPI:1003298852
Name:BAKER, BRANDI JANECE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:JANECE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:17180 ROYAL PALM BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2394
Practice Address - Country:US
Practice Address - Phone:954-276-1474
Practice Address - Fax:954-285-6026
Is Sole Proprietor?:No
Enumeration Date:2015-06-28
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20190060162084N0400X
FLME1449492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107413300Medicaid