Provider Demographics
NPI:1174962807
Name:BRANDES, WAYNE SCALI (DO)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:SCALI
Last Name:BRANDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-6555
Mailing Address - Fax:321-434-6557
Practice Address - Street 1:7125 MURRELL RD STE F
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7999
Practice Address - Country:US
Practice Address - Phone:321-434-6555
Practice Address - Fax:321-434-6557
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-16
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS13118207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS13118OtherMEDICAL LICENSE
FLIE823ZOtherMEDICARE