Healthcare Provider Details

I. General information

NPI: 1003746009
Provider Name (Legal Business Name): SHANNEN RAE BRADLEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 CHINA FIR PL
SIMI VALLEY CA
93065-7238
US

IV. Provider business mailing address

3124 CHINA FIR PL
SIMI VALLEY CA
93065-7238
US

V. Phone/Fax

Practice location:
  • Phone: 818-723-1579
  • Fax:
Mailing address:
  • Phone: 818-723-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: