Provider Demographics
NPI:1306486683
Name:PRYOR, BRANDI MERCEDES (HCO PROVIDER)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:MERCEDES
Last Name:PRYOR
Suffix:
Gender:F
Credentials:HCO PROVIDER
Other - Prefix:
Other - First Name:CHERISHED
Other - Middle Name:HOME
Other - Last Name:SERVICES LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HCO PROVIDER
Mailing Address - Street 1:2412 CREEKMORE CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8843
Mailing Address - Country:US
Mailing Address - Phone:757-319-0912
Mailing Address - Fax:
Practice Address - Street 1:3574 HOLLAND RD STE 204
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4063
Practice Address - Country:US
Practice Address - Phone:757-220-2396
Practice Address - Fax:757-220-2396
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2978-01-001172V00000X
VAHCO-222657172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker