Provider Demographics
NPI:1083393300
Name:REYNOLDS, BRANDON JOHN
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JOHN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1466
Mailing Address - Country:US
Mailing Address - Phone:508-269-2247
Mailing Address - Fax:
Practice Address - Street 1:3 VIKING DR
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1466
Practice Address - Country:US
Practice Address - Phone:508-269-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator