Provider Demographics
NPI:1114025202
Name:BRADY, PATRICIA K IV (RN, NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:K
Last Name:BRADY
Suffix:IV
Gender:F
Credentials:RN, NP
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Other - First Name:
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Mailing Address - Street 1:90 PRESIDENTIAL PLAZA
Mailing Address - Street 2:UNIVERSITY HEALTH CARE CENTER
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-464-8224
Mailing Address - Fax:315-464-2187
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:UNIVERSITY HEALTH CARE CENTER
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-8224
Practice Address - Fax:315-464-2187
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF300014-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC3904Medicare UPIN