Provider Demographics
NPI:1548807100
Name:BRANDY, KEANTHA
Entity type:Individual
Prefix:
First Name:KEANTHA
Middle Name:
Last Name:BRANDY
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 1:9519 TRIANGLE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8950
Mailing Address - Country:US
Mailing Address - Phone:513-356-1221
Mailing Address - Fax:
Practice Address - Street 1:6200 SNIDER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2640
Practice Address - Country:US
Practice Address - Phone:513-223-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400365570504376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide