Provider Demographics
NPI:1023066248
Name:BRADSHAW, DEBORAH Y (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:Y
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:HAZEL
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:90 PRESIDENTIAL PLZ
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2240
Mailing Address - Country:US
Mailing Address - Phone:315-464-4243
Mailing Address - Fax:315-464-5359
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-4243
Practice Address - Fax:315-464-5359
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1791212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01226402Medicaid
NY01226402Medicaid
NYP130004538Medicare PIN