Provider Demographics
NPI:1598507329
Name:RAWLEIGH, BRANDON LEE (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:RAWLEIGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SOUTHVIEW DR APT 305
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-9757
Mailing Address - Country:US
Mailing Address - Phone:607-590-1983
Mailing Address - Fax:
Practice Address - Street 1:52 SOUTHVIEW DR APT 201
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-9753
Practice Address - Country:US
Practice Address - Phone:585-332-3221
Practice Address - Fax:607-590-1983
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1987523103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent