Provider Demographics
NPI:1760466932
Name:BRADSHAW, YLISABYTH S (DO)
Entity Type:Individual
Prefix:DR
First Name:YLISABYTH
Middle Name:S
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:1 GENERAL ST
Mailing Address - Street 2:DIRECTOR OF MANAGED CARE-ANDREA
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2961
Mailing Address - Country:US
Mailing Address - Phone:978-683-4000
Mailing Address - Fax:978-946-8017
Practice Address - Street 1:1 GENERAL ST
Practice Address - Street 2:DIRECTOR OF MANAGED CARE-ANDREA
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2961
Practice Address - Country:US
Practice Address - Phone:978-683-4000
Practice Address - Fax:978-946-8017
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA45862207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA54243Medicare UPIN