Gennel Tanisha Bradley, MS ED
Individual provider Active NPI Specialist · Freeport, NY
NPI 1912409608 · NPPES record last updated Mar 8, 2018
Key facts
- NPI
- 1912409608
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 8 Wilshire CT
Freeport, NY 11520-6233 - Phone
- (516) 749-3851
- NPI assigned
- Mar 8, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | NY | Yes |
Addresses
Primary practice location
8 Wilshire CT
Freeport, NY 11520-6233
Mailing address
8 Wilshire CT
Freeport, NY 11520-6233
Other providers in Freeport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.