Healthcare Provider Details

I. General information

NPI: 1184751042
Provider Name (Legal Business Name): BRADLEY JAMES SANDELLA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/10/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

501 W 14TH ST
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-9420
  • Fax:
Mailing address:
  • Phone: 302-320-9420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberC2-0010025
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: