Provider Demographics
NPI:1417118118
Name:NEDELLA, BRENT A (DO, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:A
Last Name:NEDELLA
Suffix:
Gender:M
Credentials:DO, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 W MCDOWELL RD STE M1342
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4878
Mailing Address - Country:US
Mailing Address - Phone:480-627-2600
Mailing Address - Fax:877-669-0465
Practice Address - Street 1:10320 W MCDOWELL RD STE M1342
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4878
Practice Address - Country:US
Practice Address - Phone:480-627-2600
Practice Address - Fax:877-669-0465
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU1731207Q00000X
WA61103612207Q00000X
CA20A19258207Q00000X
AZ005317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine