Provider Demographics
NPI:1538795372
Name:BRAWDY, ANNALISA
Entity type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:BRAWDY
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 1:5728 MAJOR BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7970
Mailing Address - Country:US
Mailing Address - Phone:407-280-3776
Mailing Address - Fax:407-454-9007
Practice Address - Street 1:5728 MAJOR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7970
Practice Address - Country:US
Practice Address - Phone:407-280-3776
Practice Address - Fax:407-454-9007
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA17540224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA17540OtherFLORIDA DEPARTMENT OF HEALTH