Provider Demographics
NPI:1962247577
Name:ST CLAIR, BRANDON
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:ST CLAIR
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 1:6740 APPLERIDGE CIR APT 1
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4937
Mailing Address - Country:US
Mailing Address - Phone:330-503-3546
Mailing Address - Fax:
Practice Address - Street 1:6740 APPLERIDGE CIR APT 1
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4937
Practice Address - Country:US
Practice Address - Phone:330-503-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide