Provider Demographics
NPI:1629940747
Name:TUE, BRANDACE
Entity type:Individual
Prefix:
First Name:BRANDACE
Middle Name:
Last Name:TUE
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 1:1805 SHETLAND WAY
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08093-1534
Mailing Address - Country:US
Mailing Address - Phone:267-279-9565
Mailing Address - Fax:
Practice Address - Street 1:1805 SHETLAND WAY
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08093-1534
Practice Address - Country:US
Practice Address - Phone:267-279-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01422400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist