Provider Demographics
NPI:1669064879
Name:STERLING, BRADLEY
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:STERLING
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 1:1224 MARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4206
Mailing Address - Country:US
Mailing Address - Phone:937-622-8799
Mailing Address - Fax:
Practice Address - Street 1:128 W CLAY ST APT D
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-3161
Practice Address - Country:US
Practice Address - Phone:937-622-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5504716374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide