Provider Demographics
NPI:1023908332
Name:BRODY, WILLIAM ANTHONY JR
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:BRODY
Suffix:JR
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 1:1309 NE 23RD ST APT A
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2320
Mailing Address - Country:US
Mailing Address - Phone:412-716-0211
Mailing Address - Fax:
Practice Address - Street 1:1309 NE 23RD ST APT A
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2320
Practice Address - Country:US
Practice Address - Phone:412-716-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9497744390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program