Provider Demographics
NPI:1851993059
Name:MANCINELLI, BRANDON KEITH (CNIM)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:KEITH
Last Name:MANCINELLI
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3497 WAGON WHEEL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0115
Mailing Address - Country:US
Mailing Address - Phone:877-295-2554
Mailing Address - Fax:
Practice Address - Street 1:3497 WAGON WHEEL RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0115
Practice Address - Country:US
Practice Address - Phone:877-295-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic