Provider Demographics
NPI:1811900525
Name:BRATTON, PAMELA DIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DIANE
Last Name:BRATTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:BRATTON
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:383 CYPRESS POINT DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-253-5890
Mailing Address - Fax:321-234-0310
Practice Address - Street 1:8050 SPYGLASS HILL RD
Practice Address - Street 2:WUESTHOFF PROGRESSIVE CARE CENTER
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-752-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3631103TC0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75722Medicare ID - Type Unspecified