Provider Demographics
NPI:1093579179
Name:BOYD, BRANDY MARINA
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:MARINA
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 REESE RD APT 520
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1294
Mailing Address - Country:US
Mailing Address - Phone:305-570-5239
Mailing Address - Fax:
Practice Address - Street 1:5800 REESE RD APT 520
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1294
Practice Address - Country:US
Practice Address - Phone:305-570-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities