Provider Demographics
NPI:1609951896
Name:BRANDON, SHAIDA TALEBREZA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAIDA
Middle Name:TALEBREZA
Last Name:BRANDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAIDA
Other - Middle Name:
Other - Last Name:TALEBREZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2799 BEVERLY STREET
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106
Mailing Address - Country:US
Mailing Address - Phone:801-300-0903
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:AB 193 SOM
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-587-9103
Practice Address - Fax:801-585-3884
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5748123-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine