Provider Demographics
NPI:1063814507
Name:STRAFACE, BRANDY M (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:STRAFACE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:527 MEDICAL PARK DR STE 401
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9010
Mailing Address - Country:US
Mailing Address - Phone:681-342-3570
Mailing Address - Fax:681-342-3575
Practice Address - Street 1:527 MEDICAL PARK DR STE 401
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9010
Practice Address - Country:US
Practice Address - Phone:681-342-3570
Practice Address - Fax:681-342-3575
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV1861363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical