Healthcare Provider Details

I. General information

NPI: 1649405879
Provider Name (Legal Business Name): BRADY BRADSHAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BLAIRS FERRY RD
HIAWATHA IA
52233-1900
US

IV. Provider business mailing address

1340 BLAIRS FERRY RD
HIAWATHA IA
52233-1900
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-6575
  • Fax:
Mailing address:
  • Phone: 319-398-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD-41765
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: