Provider Demographics
NPI:1619986429
Name:WIESZBICKI, BRIAN STANLEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:STANLEY
Last Name:WIESZBICKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 541209
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32954-1209
Mailing Address - Country:US
Mailing Address - Phone:321-453-4628
Mailing Address - Fax:
Practice Address - Street 1:1834 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4716
Practice Address - Country:US
Practice Address - Phone:407-627-0062
Practice Address - Fax:407-674-7346
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2455213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist