Provider Demographics
NPI:1518671551
Name:BRANDAO, SORAYA
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:
Last Name:BRANDAO
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 1:1208 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:774-434-7716
Mailing Address - Fax:
Practice Address - Street 1:1208 WARREN AVE
Practice Address - Street 2:1
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6854
Practice Address - Country:US
Practice Address - Phone:774-434-7716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician