Provider Demographics
NPI:1477441640
Name:PRAIRIE, BRANDYN ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:BRANDYN
Middle Name:ELIZABETH
Last Name:PRAIRIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COUNTY ROUTE 24
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-3923
Mailing Address - Country:US
Mailing Address - Phone:518-651-7476
Mailing Address - Fax:
Practice Address - Street 1:111 COUNTY ROUTE 24
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-3923
Practice Address - Country:US
Practice Address - Phone:518-651-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist