Provider Demographics
NPI:1891574539
Name:SCHLEGEL, BRANDT MATTHEW
Entity Type:Individual
Prefix:
First Name:BRANDT
Middle Name:MATTHEW
Last Name:SCHLEGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-3311
Mailing Address - Country:US
Mailing Address - Phone:904-647-1849
Mailing Address - Fax:
Practice Address - Street 1:997 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-3311
Practice Address - Country:US
Practice Address - Phone:904-647-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician