Provider Demographics
NPI:1497514020
Name:DELOSH, BRANDY MARIE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:MARIE
Last Name:DELOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:M
Other - Last Name:QUAIFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1144
Mailing Address - Country:US
Mailing Address - Phone:315-212-4326
Mailing Address - Fax:
Practice Address - Street 1:16 PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-2016
Practice Address - Country:US
Practice Address - Phone:315-764-8076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist