Provider Demographics
NPI:1821405127
Name:PERVIS, BRANDON SR (APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:PERVIS
Suffix:SR
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DIXWELL AVE STE 278
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3403
Mailing Address - Country:US
Mailing Address - Phone:203-957-3938
Mailing Address - Fax:
Practice Address - Street 1:83 WOOSTER HTS STE 125
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7550
Practice Address - Country:US
Practice Address - Phone:203-957-3938
Practice Address - Fax:866-266-4842
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5748363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner