Provider Demographics
NPI:1083599989
Name:BRANDT, ANELIESE DEVEAU
Entity type:Individual
Prefix:
First Name:ANELIESE
Middle Name:DEVEAU
Last Name:BRANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-0554
Mailing Address - Country:US
Mailing Address - Phone:716-759-5579
Mailing Address - Fax:716-759-1759
Practice Address - Street 1:9276 MAIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1969
Practice Address - Country:US
Practice Address - Phone:716-759-7759
Practice Address - Fax:716-759-1759
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34189363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant