Healthcare Provider Details

I. General information

NPI: 1114139698
Provider Name (Legal Business Name): KATHERINE MARY BRADSHAW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 3RD AVE
NEW YORK NY
10029
US

IV. Provider business mailing address

2089 3RD AVE
NEW YORK NY
10029-2184
US

V. Phone/Fax

Practice location:
  • Phone: 212-828-6144
  • Fax: 212-828-6145
Mailing address:
  • Phone: 212-828-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number247830
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: