Provider Demographics
NPI:1487419974
Name:CODY, BRANDON LAMAR (STNA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LAMAR
Last Name:CODY
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-4169
Mailing Address - Country:US
Mailing Address - Phone:216-463-2433
Mailing Address - Fax:
Practice Address - Street 1:5641 SAXON DR
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-4169
Practice Address - Country:US
Practice Address - Phone:216-463-2433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health