Provider Demographics
NPI:1235999251
Name:MERRILL, BRANDON C
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:C
Last Name:MERRILL
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 1:534 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2335
Mailing Address - Country:US
Mailing Address - Phone:407-590-6254
Mailing Address - Fax:
Practice Address - Street 1:534 1ST ST
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2335
Practice Address - Country:US
Practice Address - Phone:407-590-6254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program