Provider Demographics
NPI:1609102276
Name:MOONEY, BRANDON EDWARD (MT, PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:EDWARD
Last Name:MOONEY
Suffix:
Gender:M
Credentials:MT, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:DESK Q10-1
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-3958
Mailing Address - Fax:216-444-7031
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:DESK Q10-1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-3958
Practice Address - Fax:216-444-7031
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.001593363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical