Provider Demographics
NPI:1114109295
Name:BRADLEY, MEREDITH (AU D)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CLINT MOORE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2768
Mailing Address - Country:US
Mailing Address - Phone:561-393-9150
Mailing Address - Fax:561-939-0195
Practice Address - Street 1:3355 BURNS RD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4353
Practice Address - Country:US
Practice Address - Phone:561-691-3373
Practice Address - Fax:561-939-0195
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1452231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist