Provider Demographics
NPI:1831494731
Name:LEE, BRANDON JUSTH (DOM)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JUSTH
Last Name:LEE
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-8535
Mailing Address - Country:US
Mailing Address - Phone:910-990-9402
Mailing Address - Fax:
Practice Address - Street 1:709 S 9TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-8535
Practice Address - Country:US
Practice Address - Phone:910-990-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9629785163W00000X
FLAP2944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse