Healthcare Provider Details

I. General information

NPI: 1659097285
Provider Name (Legal Business Name): ADESTELA BRADLEY MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 MIRAMAR PKWY STE 304
MIRAMAR FL
33025-5820
US

IV. Provider business mailing address

10831 EDINBURGH ST
HOLLYWOOD FL
33026-4715
US

V. Phone/Fax

Practice location:
  • Phone: 754-202-0075
  • Fax:
Mailing address:
  • Phone: 754-202-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: