Provider Demographics
NPI:1295454072
Name:BRADY, MAUREEN ANNE (ANP-C)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANNE
Last Name:BRADY
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 LITTLE YORK RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2231
Mailing Address - Country:US
Mailing Address - Phone:845-987-4422
Mailing Address - Fax:
Practice Address - Street 1:48 LITTLE YORK RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-2231
Practice Address - Country:US
Practice Address - Phone:845-987-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310838363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health