Provider Demographics
NPI:1558245092
Name:VACCHIO, BRANDON MICHEAL (PRSS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHEAL
Last Name:VACCHIO
Suffix:
Gender:M
Credentials:PRSS
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 299
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-0299
Mailing Address - Country:US
Mailing Address - Phone:304-359-2185
Mailing Address - Fax:304-359-2306
Practice Address - Street 1:36 N MARSHAM ST
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1623
Practice Address - Country:US
Practice Address - Phone:304-359-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24-913175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty