Provider Demographics
NPI:1114078672
Name:TANKERSLEY, BRANDYE SHAVAUN
Entity type:Individual
Prefix:MS
First Name:BRANDYE
Middle Name:SHAVAUN
Last Name:TANKERSLEY
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 1:2216 CHENEVERT ST # 6
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-5833
Mailing Address - Country:US
Mailing Address - Phone:832-654-2864
Mailing Address - Fax:713-492-0990
Practice Address - Street 1:5319 NEWKIRK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-3133
Practice Address - Country:US
Practice Address - Phone:713-492-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program