Provider Demographics
NPI:1770813784
Name:BRADY, NEAL CEARAN (LAC)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:CEARAN
Last Name:BRADY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 BONANZA CT
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2026
Mailing Address - Country:US
Mailing Address - Phone:954-993-0994
Mailing Address - Fax:
Practice Address - Street 1:300 WILSHIRE BLVD
Practice Address - Street 2:SUITE 237
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5378
Practice Address - Country:US
Practice Address - Phone:954-993-0994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2300171100000X
ORAC 155575171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist