Provider Demographics
NPI:1043447543
Name:BRADSHAW-SYDNOR, AYANNA CELESTE (DDS)
Entity Type:Individual
Prefix:MS
First Name:AYANNA
Middle Name:CELESTE
Last Name:BRADSHAW-SYDNOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 HOBART ST
Mailing Address - Street 2:JEWISH RENAISSANCE MEDICAL CENTER-DENTAL DEPARTMENT
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3396
Mailing Address - Country:US
Mailing Address - Phone:973-376-9333
Mailing Address - Fax:973-293-0139
Practice Address - Street 1:72 N MUNN AVE
Practice Address - Street 2:APARTMENT #1
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-4122
Practice Address - Country:US
Practice Address - Phone:404-323-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ220102489001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice