Provider Demographics
NPI:1790566024
Name:SHIRODA, BRENDEN J
Entity Type:Individual
Prefix:
First Name:BRENDEN
Middle Name:J
Last Name:SHIRODA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W144S7188 HIDDEN CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-3627
Mailing Address - Country:US
Mailing Address - Phone:262-895-9477
Mailing Address - Fax:
Practice Address - Street 1:W144S7188 HIDDEN CREEK CT
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-3627
Practice Address - Country:US
Practice Address - Phone:262-895-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer