Provider Demographics
NPI:1972183275
Name:BRADLEY, SHUCHEMIA NICOLE
Entity Type:Individual
Prefix:DR
First Name:SHUCHEMIA
Middle Name:NICOLE
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 1:7725 SAINT ANDREWS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2957
Mailing Address - Country:US
Mailing Address - Phone:770-865-8600
Mailing Address - Fax:
Practice Address - Street 1:7725 SAINT ANDREWS RD STE 3
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2957
Practice Address - Country:US
Practice Address - Phone:770-865-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-11
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty