Provider Demographics
NPI:1386006443
Name:LEY, BRENDA (AP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:LEY
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 LENA RD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9442
Mailing Address - Country:US
Mailing Address - Phone:941-301-8485
Mailing Address - Fax:
Practice Address - Street 1:5325 LENA RD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9442
Practice Address - Country:US
Practice Address - Phone:941-301-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3122171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist