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General NPI Number Information
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NPI Number | 1134204977
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Entity Type | Individual
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Provider Name | SHELLEY MARIE BRADY LMP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 169 S STEVENS ST STE 101 SUITE 101
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City | SPOKANE
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State | WA
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Zip | 99201-1200
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Country | US
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Telephone | 509-939-4648
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Fax | 321-260-6634
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Provider Business Mailing Address
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Address Line | 169 S STEVENS ST STE 101 SUITE 101
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City | SPOKANE
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State | WA
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Zip | 99201-1200
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Country | US
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Telephone | 509-939-4648
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Fax | 321-260-5100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA5184
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License Number State | WA
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