Provider Demographics
NPI:1407184450
Name:BRANDY'S SHOES INC.
Entity type:Organization
Organization Name:BRANDY'S SHOES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:BRANSDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-943-9667
Mailing Address - Street 1:1290 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3705
Mailing Address - Country:US
Mailing Address - Phone:954-943-9667
Mailing Address - Fax:954-941-9204
Practice Address - Street 1:1290 NORTH FED HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BCH
Practice Address - State:FL
Practice Address - Zip Code:33062-3705
Practice Address - Country:US
Practice Address - Phone:954-943-9667
Practice Address - Fax:954-941-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6405510001Medicare NSC