Provider Demographics
NPI:1013203272
Name:SHOSS, BRADLEY LEONE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:LEONE
Last Name:SHOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4706
Mailing Address - Country:US
Mailing Address - Phone:407-775-7654
Mailing Address - Fax:407-834-6082
Practice Address - Street 1:160 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4706
Practice Address - Country:US
Practice Address - Phone:407-339-0303
Practice Address - Fax:407-339-0961
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015007985207W00000X
FLME127081207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018716300Medicaid
FLIQ821UMedicare PIN
FL018716300Medicaid
FLIQ821WMedicare PIN
FLIQ821XMedicare PIN
FLIQ821VMedicare PIN