Provider Demographics
NPI:1811721079
Name:BRANDI, MADISON LEIGH
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LEIGH
Last Name:BRANDI
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 1:350 OLD ROUTE 940 APT 101
Mailing Address - Street 2:
Mailing Address - City:POCONO PINES
Mailing Address - State:PA
Mailing Address - Zip Code:18350-7718
Mailing Address - Country:US
Mailing Address - Phone:570-580-8721
Mailing Address - Fax:
Practice Address - Street 1:350 OLD ROUTE 940 APT 101
Practice Address - Street 2:
Practice Address - City:POCONO PINES
Practice Address - State:PA
Practice Address - Zip Code:18350-7718
Practice Address - Country:US
Practice Address - Phone:570-580-8721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer