Healthcare Provider Details

I. General information

NPI: 1922895150
Provider Name (Legal Business Name): SHENAN BRADSHAW DDS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 SUMMIT CROSSING PL STE 303
GASTONIA NC
28054-2183
US

IV. Provider business mailing address

660 SUMMIT CROSSING PL STE 303
GASTONIA NC
28054-2183
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-0081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: SHEILA EATON
Title or Position: PRACTICE LEADER
Credential:
Phone: 704-865-0081