Provider Demographics
NPI:1952536914
Name:BRANDSTETTER, JENNIFER MOORE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MOORE
Last Name:BRANDSTETTER
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 1:10524 EUCLID AVE FL 13
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2205
Mailing Address - Country:US
Mailing Address - Phone:216-983-5657
Mailing Address - Fax:216-844-5833
Practice Address - Street 1:10524 EUCLID AVE
Practice Address - Street 2:WO WALKER CENTER - 13TH FLOOR
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2205
Practice Address - Country:US
Practice Address - Phone:216-983-5650
Practice Address - Fax:216-844-5833
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.0999382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program