Provider Demographics
NPI:1851687693
Name:BRANDON, SCOTT A (CST,CSFA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:BRANDON
Suffix:
Gender:M
Credentials:CST,CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 DERBYSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5358
Mailing Address - Country:US
Mailing Address - Phone:702-445-4166
Mailing Address - Fax:
Practice Address - Street 1:1857 DERBYSHIRE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5358
Practice Address - Country:US
Practice Address - Phone:702-445-4166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV125635246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant