Individual
BRANDON DESHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 WOODLAND AVE STE 7, WEST GROVE, PA 19390-1137
(302) 235-9215
Mailing address
105 WOODLAND AVE STE 7, WEST GROVE, PA 19390-1137
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1022346
PA
Other
Enumeration date
06/02/2022
Last updated
06/02/2022
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