Provider Demographics
NPI:1770047649
Name:BRADLEY, SHELIA S
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:S
Last Name:BRADLEY
Suffix:
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 1:107 S KINGS DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-9476
Mailing Address - Country:US
Mailing Address - Phone:864-365-8596
Mailing Address - Fax:
Practice Address - Street 1:107 S KINGS DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-9476
Practice Address - Country:US
Practice Address - Phone:864-365-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide