Provider Demographics
NPI:1013203272
Name:SHOSS, BRADLEY LEONE (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:LEONE
Last Name:SHOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CONCOURSE PKWY S STE 200
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6114
Mailing Address - Country:US
Mailing Address - Phone:407-767-6411
Mailing Address - Fax:407-767-8160
Practice Address - Street 1:790 CONCOURSE PKWY S STE 200
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6114
Practice Address - Country:US
Practice Address - Phone:407-767-6411
Practice Address - Fax:407-767-8160
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015007985207W00000X
FLME127081207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018716300Medicaid
FLIQ821UMedicare PIN
FL018716300Medicaid
FLIQ821WMedicare PIN
FLIQ821XMedicare PIN
FLIQ821VMedicare PIN