Provider Demographics
NPI:1871633495
Name:BRANDON, MARIA ANNA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANNA
Last Name:BRANDON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ANNA
Other - Last Name:BRANDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:7707 LONE SHEPHERD DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5119
Mailing Address - Country:US
Mailing Address - Phone:631-796-8224
Mailing Address - Fax:
Practice Address - Street 1:7707 LONE SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-5119
Practice Address - Country:US
Practice Address - Phone:631-796-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016287235Z00000X
NV1250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist