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General NPI Number Information
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NPI Number | 1225825540
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Entity Type | Individual
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Provider Name | CHEYANNE SIECRRA BRADLEY
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Gender | Female
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 19536 SHADY LANE AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1630
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Country | US
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Telephone | 313-808-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 19536 SHADY LANE AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1630
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Country | US
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Telephone | 313-808-3338
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Fax |
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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