Provider Demographics
NPI:1356938518
Name:BRADDY, SHIRLEY
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:BRADDY
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 1:31 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:DAVISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26142-9771
Mailing Address - Country:US
Mailing Address - Phone:304-483-1999
Mailing Address - Fax:
Practice Address - Street 1:31 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:DAVISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26142-9771
Practice Address - Country:US
Practice Address - Phone:304-483-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant