Provider Demographics
NPI:1659825222
Name:MEDINA, BRANDY LEE-TAYLOR
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LEE-TAYLOR
Last Name:MEDINA
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 1:23610 WILLOW HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1669
Mailing Address - Country:US
Mailing Address - Phone:713-306-5123
Mailing Address - Fax:
Practice Address - Street 1:23610 WILLOW HAVEN DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-1669
Practice Address - Country:US
Practice Address - Phone:713-306-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist