Healthcare Provider Details

I. General information

NPI: 1093552200
Provider Name (Legal Business Name): SYDNEE R BRADSHAW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 UNDERWOOD ST FL 4
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

22 UNDERWOOD ST FL 4
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 407-648-5384
  • Fax: 407-872-7754
Mailing address:
  • Phone: 407-648-5384
  • Fax: 407-872-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9121338
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC09541
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: