Provider Demographics
NPI:1942199187
Name:RICHARDS, BRANDON ANDREW
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:ANDREW
Last Name:RICHARDS
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 1:1404 19TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3502
Mailing Address - Country:US
Mailing Address - Phone:234-458-3922
Mailing Address - Fax:234-458-3922
Practice Address - Street 1:1404 19TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3502
Practice Address - Country:US
Practice Address - Phone:234-458-3922
Practice Address - Fax:234-458-3922
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006572175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist