Provider Demographics
NPI:1528204211
Name:BRADT, SANDRA L II
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:BRADT
Suffix:II
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 1:2 MURRAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-1122
Mailing Address - Country:US
Mailing Address - Phone:585-243-7290
Mailing Address - Fax:585-243-7287
Practice Address - Street 1:2 MURRAY HILL DR
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1122
Practice Address - Country:US
Practice Address - Phone:585-243-7290
Practice Address - Fax:585-243-7287
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273847-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health