Provider Demographics
NPI:1902054497
Name:CHARLES, BRANDY R (AUD)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:R
Last Name:CHARLES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MRS
Other - First Name:BRANDY
Other - Middle Name:RENEE
Other - Last Name:WINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:802 LANDMARK DR
Mailing Address - Street 2:STE 119
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:301-315-5888
Mailing Address - Fax:301-315-5866
Practice Address - Street 1:802 LANDMARK DR STE 119
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-760-8840
Practice Address - Fax:410-367-2464
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006087231H00000X
KY0560231H00000X
MD01368231H00000X, 237600000X
MD237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169Medicare PIN