Teresa Pullara Brandt, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME0038477 Issued in FL

Practice address

621 Medical Care Dr
Brandon, FL 33511-5942

Phone

(813) 657-3330

Fax

(813) 657-3348

NPI assigned

Jul 12, 2005

Last updated

Nov 30, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354233600000",
    "number": "1831197060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 MEDICAL CARE DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115942",
            "telephone_number": "813-657-3330",
            "fax_number": "813-657-3348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 MEDICAL CARE DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115942",
            "telephone_number": "813-657-3330",
            "fax_number": "813-657-3348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDT",
        "first_name": "TERESA",
        "middle_name": "PULLARA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-12",
        "last_updated": "2012-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME0038477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "30404",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "068641700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Stem Cell Clinic LLC
• Brandon TMS & Psychiatry
• Brandon Wellness Center LLC
• Brandon-Riverview Medical Associates PA
• Ashley Quonsha Shavar Brandon, APRN
• Kathryn Brannan, LMHC
• Melanie Brannan, M.S., C.C.C.
• Elaine Mary Brantley, D.O.
• Melissa Braughton
• Richard Deguzman Bravo Jr., DO

• Specialist in Brandon, FL
• Providers in Brandon, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2012; 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.