Provider Demographics
NPI:1114353976
Name:ASTUDILLO-MOUNIER, BRANDIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:ANN
Last Name:ASTUDILLO-MOUNIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-0069
Mailing Address - Country:US
Mailing Address - Phone:561-932-0995
Mailing Address - Fax:561-932-0997
Practice Address - Street 1:3401 PGA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2824
Practice Address - Country:US
Practice Address - Phone:561-219-1000
Practice Address - Fax:561-694-6018
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010753200Medicaid
ME67289OtherMEDICAL LICENSE
ME67289OtherMEDICAL LICENSE