Provider Demographics
NPI:1578299533
Name:CECIL, BRANDI SHAY
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SHAY
Last Name:CECIL
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 1:881 HOBBS LN
Mailing Address - Street 2:
Mailing Address - City:COXS CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40013-7744
Mailing Address - Country:US
Mailing Address - Phone:502-460-7127
Mailing Address - Fax:
Practice Address - Street 1:204 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1218
Practice Address - Country:US
Practice Address - Phone:502-588-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY1161738163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health