Provider Demographics
NPI:1891341632
Name:BRADLEY, SHARI LEE
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:LEE
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 1:135 W TWELVE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5639
Mailing Address - Country:US
Mailing Address - Phone:910-759-9468
Mailing Address - Fax:
Practice Address - Street 1:135 W TWELVE OAKS RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5639
Practice Address - Country:US
Practice Address - Phone:910-759-9468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider