Provider Demographics
NPI:1689988503
Name:CYNTHIA M. BRADLEY, M.D., P.A.
Entity Type:Organization
Organization Name:CYNTHIA M. BRADLEY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-278-8440
Mailing Address - Street 1:8750 SW 144TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7296
Mailing Address - Country:US
Mailing Address - Phone:305-278-8440
Mailing Address - Fax:305-278-8442
Practice Address - Street 1:8750 SW 144TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7296
Practice Address - Country:US
Practice Address - Phone:305-278-8440
Practice Address - Fax:305-278-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58525174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty