Active NPI
Michelle Bradley
- Specialist
- Staten Island, NY
National Provider Identifier
1114348646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 167 Ramona Ave
Staten Island, NY 10312-2716 - Phone
- (347) 838-6951
- NPI assigned
- Dec 31, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
167 Ramona Ave
Staten Island, NY 10312-2716
Mailing address
167 Ramona Ave
Staten Island, NY 10312-2716
Phone (347) 838-6951
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103600462 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388448000000",
"number": "1114348646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "167 RAMONA AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103122716",
"telephone_number": "347-838-6951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "167 RAMONA AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103122716",
"telephone_number": "347-838-6951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "MICHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-31",
"last_updated": "2013-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103600462",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.