Provider Demographics
NPI:1336335389
Name:DESMOND, BRANDI MARIE
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:MARIE
Last Name:DESMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 TALISMAN DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-4088
Mailing Address - Country:US
Mailing Address - Phone:904-291-2981
Mailing Address - Fax:904-406-4580
Practice Address - Street 1:3228 TALISMAN DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-4088
Practice Address - Country:US
Practice Address - Phone:904-291-2981
Practice Address - Fax:904-406-4580
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor