Provider Demographics
NPI:1821565532
Name:BRANDY, MABEL DANIELLE (RN)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:DANIELLE
Last Name:BRANDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 LEMON ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4026
Mailing Address - Country:US
Mailing Address - Phone:631-336-1013
Mailing Address - Fax:
Practice Address - Street 1:400 CROOKED HILL RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1039
Practice Address - Country:US
Practice Address - Phone:631-232-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY739636-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse