Provider Demographics
NPI:1427925478
Name:SMITH, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4237
Mailing Address - Country:US
Mailing Address - Phone:757-256-7455
Mailing Address - Fax:
Practice Address - Street 1:2715 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4237
Practice Address - Country:US
Practice Address - Phone:757-256-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA224ZR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224ZR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantDriving and Community MobilityGroup - Multi-Specialty