Provider Demographics
NPI:1528880671
Name:BRANDON, PORSHA RONNAYE PHYLICIA
Entity type:Individual
Prefix:
First Name:PORSHA
Middle Name:RONNAYE PHYLICIA
Last Name:BRANDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38022
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-0022
Mailing Address - Country:US
Mailing Address - Phone:313-685-2586
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 38022
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-0022
Practice Address - Country:US
Practice Address - Phone:313-685-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care