Basic Information
| Provider Information | |||||||||
| NPI: | 1174572259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANDT | ||||||||
| FirstName: | SUSANA | ||||||||
| MiddleName: | ZAMORA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 NW 49TH ST STE 125 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547596600 | ||||||||
| FaxNumber: | 9547596665 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 NW 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333119026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547596600 | ||||||||
| FaxNumber: | 9547596665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME105831 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.