Provider Demographics
NPI:1184097826
Name:AZEVEDO, BROOKE (BS, IBCLC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:AZEVEDO
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 KATHMERE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3809
Mailing Address - Country:US
Mailing Address - Phone:805-709-1133
Mailing Address - Fax:
Practice Address - Street 1:33 KATHMERE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3809
Practice Address - Country:US
Practice Address - Phone:805-709-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-83692174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN