Provider Demographics
NPI:1356407068
Name:BRANDYS, EWA B (MD)
Entity type:Individual
Prefix:
First Name:EWA
Middle Name:B
Last Name:BRANDYS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:13535 NEMOURS PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7402
Practice Address - Country:US
Practice Address - Phone:407-567-4000
Practice Address - Fax:407-567-5924
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4208762081P0010X
AZ446892081P0010X
MDD00606012081P0010X
FLME1246232081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356407068Medicaid
WV3810013075Medicaid
PA102001117Medicaid
OH2833581Medicaid
MD408684800Medicaid
MD64693801OtherCAREFIRST BC BS
NY1356407068Medicaid
NJ0101354Medicaid
TN4048274Medicaid
FL015325900Medicaid
I41266Medicare UPIN
MDK631M401Medicare ID - Type Unspecified