Individual
BRANDY SHARESE PENDERGRASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9777 QUEENS BLVD PH, REGO PARK, NY 11374-3300
(718) 830-9274
Mailing address
1211 SOUTHERN BLVD, APT. 810, BRONX, NY 10459-4604
(347) 824-9664
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
09/17/2016
Last updated
09/17/2016
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