Provider Demographics
NPI:1912564394
Name:FELDER, BRENDA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:FELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:FELDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HAIR LOSS SPECIALIST
Mailing Address - Street 1:8000 AVONLEA PL APT 401
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-7135
Mailing Address - Country:US
Mailing Address - Phone:770-298-3090
Mailing Address - Fax:
Practice Address - Street 1:8000 AVONLEA PL APT 401
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-7135
Practice Address - Country:US
Practice Address - Phone:770-298-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management