Ayanna Celeste Bradshaw-Sydnor, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22010248900 Issued in NJ

Practice address

72 N Munn Ave
Apartment #1
East Orange, NJ 07017-4122

Phone

(404) 323-1569

NPI assigned

Jun 11, 2009

Last updated

Jun 11, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339372800000",
    "number": "1043447543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 HOBART ST",
            "address_2": "JEWISH RENAISSANCE MEDICAL CENTER-DENTAL DEPARTMENT",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088613396",
            "telephone_number": "973-376-9333",
            "fax_number": "973-293-0139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 N MUNN AVE",
            "address_2": "APARTMENT #1",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070174122",
            "telephone_number": "404-323-1569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW-SYDNOR",
        "first_name": "AYANNA",
        "middle_name": "CELESTE",
        "name_prefix": "Ms.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-11",
        "last_updated": "2012-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22010248900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Verlinger Boucher, MSED
• Jessica Bowen
• Ramonita Bracy
• Jada Crystal Bradberry, LMSW
• Bella Bradford
• Sasha Branch, LCADC
• Sonia A Bratcher
• Carolina Bravo
• Edward Brazaitis Sr., MD
• Michele M Brennan, RD,CDE

• General Practice Dentistry in East Orange, NJ
• Providers in East Orange, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.