Healthcare Provider Details

I. General information

NPI: 1154865145
Provider Name (Legal Business Name): SHEILA CONWAY BRADLEY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST FL 14
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

PO BOX 27036
NEW YORK NY
10087-7036
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-0914
  • Fax: 212-305-4343
Mailing address:
  • Phone: 212-305-9576
  • Fax: 212-305-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340084-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberF340084-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: