Provider Demographics
NPI:1205289980
Name:BRADSHAW, YANIA (BCABA)
Entity type:Individual
Prefix:
First Name:YANIA
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 LAKE MARGARET DR.
Mailing Address - Street 2:APT 1210
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812
Mailing Address - Country:US
Mailing Address - Phone:786-564-0853
Mailing Address - Fax:
Practice Address - Street 1:5212 LAKE MARGARET DR.
Practice Address - Street 2:APT 1210
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812
Practice Address - Country:US
Practice Address - Phone:786-564-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst