Shenan Marie Bradshaw, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2020029150 Issued in MO

Practice address

17300 N Outer 40 Rd Ste 103
Chesterfield, MO 63005-1364

Phone

(636) 536-5158

NPI assigned

Mar 16, 2012

Last updated

Jan 18, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 7, 2022 through Apr 7, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: shenan.bradshaw.p1@direct.affiniahealthcare.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michael K Parsons DDS PC

  dba Midwest Oral and Maxillo Facial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • O'Fallon, MO
  • NPI 1457484222

  Single Specialty

  NPD (past)
• Peachtree Dunwoody Oral and Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Atlanta, GA
  • NPI 1770981763
  NPD (past)
• Rowan Oral & Facial Surgery PC

  dba MOoresville Oral Surgery

  • Specialist
  • Mooresville, NC
  • NPI 1376595413

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737158400000",
    "number": "1699040121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17300 N OUTER 40 RD STE 103",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051364",
            "telephone_number": "636-536-5158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17300 N OUTER 40 RD STE 103",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051364",
            "telephone_number": "636-536-5158"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1487 US Highway 61 Ste B",
            "address_purpose": "LOCATION",
            "city": "Festus",
            "state": "MO",
            "postal_code": "630284164",
            "country_code": "US",
            "telephone_number": "636-931-8000",
            "fax_number": "636-931-8001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "SHENAN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-16",
        "last_updated": "2025-01-18",
        "certification_date": "2025-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "2020029150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "2021010068",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "2020029150",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert William Boyle, D.M.D.
• Danielle Bozzardi-Jerome, PHARM.D.
• David B Braby, M.D.
• Joanna M Brademeyer, CRNA
• Earniecia Mae Bradley, LPN
• Leah Brancheck, M.D.
• Sarah Diane Brandt, DPT
• Kyle Branson, DO
• Steven Lee Branstetter Jr., O.D.
• Cody Bratton

• Oral and Maxillofacial Surgery (Dentist) in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2025; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.