Provider Demographics
NPI:1871186189
Name:CARRAL, BRANDYN NICOLE
Entity Type:Individual
Prefix:
First Name:BRANDYN
Middle Name:NICOLE
Last Name:CARRAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDYN
Other - Middle Name:NICOLE
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13574 VILLAGE PARK DR STE 205
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7694
Mailing Address - Country:US
Mailing Address - Phone:407-990-2847
Mailing Address - Fax:
Practice Address - Street 1:13574 VILLAGE PARK DR STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7694
Practice Address - Country:US
Practice Address - Phone:407-990-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI47102355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty