Provider Demographics
NPI:1336902204
Name:COLBERT, BRANDY NUMARIA SHAMI
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:NUMARIA SHAMI
Last Name:COLBERT
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:PO BOX 2341
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33526-2341
Mailing Address - Country:US
Mailing Address - Phone:813-479-8398
Mailing Address - Fax:
Practice Address - Street 1:37818 COLINA DR
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-6029
Practice Address - Country:US
Practice Address - Phone:813-479-8398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239876376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker