Provider Demographics
NPI:1386308401
Name:LEBIODA, BRANDON (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:LEBIODA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 BREZZA LN APT 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2520
Mailing Address - Country:US
Mailing Address - Phone:586-453-1917
Mailing Address - Fax:
Practice Address - Street 1:900 W 38TH ST STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1130
Practice Address - Country:US
Practice Address - Phone:586-453-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant