Provider Demographics
NPI:1790270635
Name:COLANDREA, BRANDON MICHAEL (EMT-B)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
Last Name:COLANDREA
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 COUNTY HIGHWAY 34A
Mailing Address - Street 2:
Mailing Address - City:SHARON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13459-9760
Mailing Address - Country:US
Mailing Address - Phone:315-867-6597
Mailing Address - Fax:518-252-3042
Practice Address - Street 1:11 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13320
Practice Address - Country:US
Practice Address - Phone:607-264-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-23
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146D00000X, 3747P1801X, 376K00000X
NY502393146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE