Provider Demographics
NPI:1154968014
Name:SCOTT, BRENDA L
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:SCOTT
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 1:711 SPRING GARDEN ST
Mailing Address - Street 2:APARTMENT 614
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3515
Mailing Address - Country:US
Mailing Address - Phone:484-424-2197
Mailing Address - Fax:
Practice Address - Street 1:711 SPRING GARDEN ST APT 614
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3515
Practice Address - Country:US
Practice Address - Phone:267-476-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider