Provider Demographics
NPI:1396178059
Name:ZIMIN, BRANDI SHAY (MS - SLP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SHAY
Last Name:ZIMIN
Suffix:
Gender:F
Credentials:MS - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-3111
Mailing Address - Country:US
Mailing Address - Phone:678-478-3450
Mailing Address - Fax:
Practice Address - Street 1:706 N PARRISH AVE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620
Practice Address - Country:US
Practice Address - Phone:229-896-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-17
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist