Provider Demographics
NPI:1487043774
Name:OBRADOVICH, NEDRA (MA)
Entity Type:Individual
Prefix:
First Name:NEDRA
Middle Name:
Last Name:OBRADOVICH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 FLORAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-4926
Mailing Address - Country:US
Mailing Address - Phone:561-236-5309
Mailing Address - Fax:
Practice Address - Street 1:3402 FLORAL AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-4926
Practice Address - Country:US
Practice Address - Phone:561-236-5309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility