Provider Demographics
NPI:1407457484
Name:CANNON, BRANDON NYGUAMY
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:NYGUAMY
Last Name:CANNON
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 1:1035 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5913
Mailing Address - Country:US
Mailing Address - Phone:504-308-3501
Mailing Address - Fax:504-247-9125
Practice Address - Street 1:1035 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5913
Practice Address - Country:US
Practice Address - Phone:504-308-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician