Provider Demographics
NPI:1649152083
Name:SIZEMORE, BRENT CHRISTIAN
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:CHRISTIAN
Last Name:SIZEMORE
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 1:18 SUNBONNET LANE
Mailing Address - Street 2:BRENTCSIZEMORE@GMAIL.COM
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713
Mailing Address - Country:US
Mailing Address - Phone:314-474-2093
Mailing Address - Fax:
Practice Address - Street 1:18 SUNBONNET LN
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-1144
Practice Address - Country:US
Practice Address - Phone:314-474-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335384164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse