Healthcare Provider Details

I. General information

NPI: 1104756717
Provider Name (Legal Business Name): JOY DE LEON BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 SHANNON PL NW
ALBUQUERQUE NM
87107-3922
US

IV. Provider business mailing address

PO BOX 4043
ALBUQUERQUE NM
87196-4043
US

V. Phone/Fax

Practice location:
  • Phone: 505-895-1816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: