Provider Demographics
NPI:1336738285
Name:BRADSHAW, SEAN THOMAS
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:THOMAS
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-7911
Mailing Address - Country:US
Mailing Address - Phone:518-588-2996
Mailing Address - Fax:
Practice Address - Street 1:112 BEACH RD
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-7911
Practice Address - Country:US
Practice Address - Phone:518-588-2996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer