Brandon Stem Cell Clinic LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

BRANDON STEM CELL CLINIC LLC

Practice address

1602 Oakfield Dr Ste 101
Brandon, FL 33511-0827

Phone

(813) 800-7836

Fax

(813) 200-2253

NPI assigned

Sep 15, 2020

Last updated

Oct 13, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Leesa Polley

Title

Owner, Founder

Phone

(850) 591-1414

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1386259323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 OAKFIELD DR STE 101",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335110827",
            "telephone_number": "813-800-7836",
            "fax_number": "813-200-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 OAKFIELD DR STE 101",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335110827",
            "telephone_number": "813-800-7836",
            "fax_number": "813-200-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON STEM CELL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-15",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "POLLEY",
        "authorized_official_first_name": "LEESA",
        "authorized_official_title_or_position": "OWNER, FOUNDER",
        "authorized_official_telephone_number": "850-591-1414",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ashley Quonsha Shavar Brandon, APRN
• Teresa Pullara Brandt, MD

• Health Service Clinic/Center in Brandon, FL
• Providers in Brandon, FL by specialty
• Health Service Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.