Charles B Bradshaw, PH.D

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

010159 Issued in NY

Practice address

750 E Adams St
Department of Neurology
Syracuse, NY 13210-2306

Phone

(315) 464-5016

Fax

(315) 464-5355

NPI assigned

May 4, 2006

Last updated

Jan 23, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232668800000",
    "number": "1780632851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-5016",
            "fax_number": "315-464-7328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "address_2": "DEPARTMENT OF NEUROLOGY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-5016",
            "fax_number": "315-464-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "CHARLES",
        "middle_name": "B",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2009-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "010159",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01207905",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra Bradford
• Jason A Bradford
• Matthew Bradford
• Bradley Counseling Services LMSW PC
• Deborah Ann Bradley, RN, NP
• Deborah Y Bradshaw, M.D.
• Jonathan Bradshaw, PHARM.D.
• Cynthia Ann Brady I, RN
• Kimberley Lashan Brady, LPN
• Patricia K Brady IV, RN, NP

• Clinical Neuropsychologist in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Clinical Neuropsychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.