Provider Demographics
NPI:1285717595
Name:JEFFERSON-BYRD, BRENDA L (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:L
Last Name:JEFFERSON-BYRD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:L
Other - Last Name:JEFFERSON-BYRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3700 BAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6596
Mailing Address - Country:US
Mailing Address - Phone:630-202-8189
Mailing Address - Fax:
Practice Address - Street 1:3535 E NEW YORK ST STE 115
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4466
Practice Address - Country:US
Practice Address - Phone:630-499-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H61709Medicare UPIN