MEDICARE: DR. SHUCHEMIA NICOLE BRADLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1972183275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHUCHEMIA NICOLE BRADLEY

Provider Business Mailing Address
First Line	:	7725 SAINT ANDREWS RD STE 3
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2957
Country	:	US
Telephone Number	:	770-865-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	7725 SAINT ANDREWS RD STE 3
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2957
Country	:	US
Telephone Number	:	770-865-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2021
Last Update Date	:	04/11/2021

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