Provider Demographics
NPI:1043937378
Name:BRADLEY, SHAILA MARIE
Entity Type:Individual
Prefix:
First Name:SHAILA
Middle Name:MARIE
Last Name:BRADLEY
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 1:21896 LILLY DR
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-0018
Mailing Address - Country:US
Mailing Address - Phone:140-569-5024
Mailing Address - Fax:
Practice Address - Street 1:5305 S WESTERN AVE STE 524
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4504
Practice Address - Country:US
Practice Address - Phone:405-731-9012
Practice Address - Fax:405-337-9711
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator