Provider Demographics
NPI:1508127598
Name:MCLEOD, BRENDA (PHLEBOTOMY TECHNOLOG)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:PHLEBOTOMY TECHNOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MANHAN ST BLDG 8 UNIT 5
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710
Mailing Address - Country:US
Mailing Address - Phone:203-419-8808
Mailing Address - Fax:
Practice Address - Street 1:150 MANHAN ST BLDG 8 UNIT 5
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710
Practice Address - Country:US
Practice Address - Phone:203-419-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20-0525Y10246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy