Healthcare Provider Details

I. General information

NPI: 1235758327
Provider Name (Legal Business Name): BRADLEY CUNDIFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 MIDLOTHIAN TPKE
NORTH CHESTERFIELD VA
23235-5116
US

IV. Provider business mailing address

501 WESTPORT ST APT 209
NORFOLK VA
23505-3964
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-8160
  • Fax:
Mailing address:
  • Phone: 502-460-6138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007271
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: