Healthcare Provider Details

I. General information

NPI: 1962872846
Provider Name (Legal Business Name): DANIELA BRADY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY CH2N
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

429 GREENWICH ST APT 6A
NEW YORK NY
10013-2051
US

V. Phone/Fax

Practice location:
  • Phone: 917-941-0023
  • Fax:
Mailing address:
  • Phone: 917-941-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: