Provider Demographics
NPI:1659569275
Name:BRADY, TRACEY J (CNA)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:J
Last Name:BRADY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH NEW BERLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13843-2260
Mailing Address - Country:US
Mailing Address - Phone:607-334-4228
Mailing Address - Fax:
Practice Address - Street 1:107 MEADOW LN
Practice Address - Street 2:
Practice Address - City:SOUTH NEW BERLIN
Practice Address - State:NY
Practice Address - Zip Code:13843-2260
Practice Address - Country:US
Practice Address - Phone:607-334-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342551080507R376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide