Provider Demographics
NPI:1245639723
Name:BRADY, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BRADY
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 1:123 GLADSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-3627
Mailing Address - Country:US
Mailing Address - Phone:631-539-8498
Mailing Address - Fax:
Practice Address - Street 1:123 GLADSTONE AVE
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-3627
Practice Address - Country:US
Practice Address - Phone:631-539-8498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY483468-1163WM0102X, 163WM0705X, 163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical