Provider Demographics
NPI:1326473380
Name:MILLER, BRANDIS (CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:BRANDIS
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 HERITAGE DR APT C
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5336
Mailing Address - Country:US
Mailing Address - Phone:845-661-1918
Mailing Address - Fax:
Practice Address - Street 1:39 HERITAGE DR APT C
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5336
Practice Address - Country:US
Practice Address - Phone:845-661-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023177-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist