Provider Demographics
NPI:1568144319
Name:RAY, BRENDA LEE (HOME CARE HOMEMAKER)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:RAY
Suffix:
Gender:F
Credentials:HOME CARE HOMEMAKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 MCMULLEN BOOTH RD N STE 247
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1370
Mailing Address - Country:US
Mailing Address - Phone:727-685-9309
Mailing Address - Fax:
Practice Address - Street 1:2451 MCMULLEN BOOTH RD N STE 247
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1370
Practice Address - Country:US
Practice Address - Phone:727-685-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care