Basic Information
Provider Information
NPI: 1003298852
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAKER
FirstName: BRANDI
MiddleName: JANECE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2900 CORPORATE WAY
Address2: DOOR D
City: MIRAMAR
State: FL
PostalCode: 330253925
CountryCode: US
TelephoneNumber: 9542765685
FaxNumber: 9549857074
Practice Location
Address1: 17180 ROYAL PALM BLVD STE 1
Address2:  
City: WESTON
State: FL
PostalCode: 333262394
CountryCode: US
TelephoneNumber: 9542761474
FaxNumber: 9542856026
Other Information
ProviderEnumerationDate: 06/28/2015
LastUpdateDate: 08/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XME144949FLY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X2019006016MON Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

ID Information
IDTypeStateIssuerDescription
10741330005FL MEDICAID


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