Provider Demographics
NPI:1609018738
Name:FRAZAO, BRANDY LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:LYNN
Last Name:FRAZAO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:BRANDY
Other - Middle Name:FRAZAO
Other - Last Name:LAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2465 S DOWNING ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5822
Mailing Address - Country:US
Mailing Address - Phone:303-778-5774
Mailing Address - Fax:303-778-2436
Practice Address - Street 1:2465 S DOWNING ST STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5822
Practice Address - Country:US
Practice Address - Phone:303-778-5774
Practice Address - Fax:303-778-2436
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COP.A.0004621363AM0700X
NC0010-01753363AM0700X
COPA.0004621363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical