Basic Information
| Provider Information | |||||||||
| NPI: | 1518369578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | BRETT | ||||||||
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| Credential: | SA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 SE 5TH AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334835172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619002498 | ||||||||
| FaxNumber: | 8889724762 | ||||||||
| Practice Location | |||||||||
| Address1: | 4215 EDGEWATER DR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328042206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075392000 | ||||||||
| FaxNumber: | 4073980050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2014 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZS0410X | N | 246ZC0007X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
ID Information
| ID | Type | State | Issuer | Description | 14-439 | 01 | FL | ABSA CERT - SURGICAL ASSISTANT-CERTIFIED | OTHER |