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General NPI Number Information
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NPI Number | 1336086685
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Entity Type | Individual
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Provider Name | QUARTAY BRADSHAW FNP-C
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Gender | Male
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 10 VALLEY FROST CT APT K
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City | COCKEYSVILLE
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State | MD
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Zip | 21030-4264
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Country | US
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Telephone | 410-900-0547
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Fax |
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Provider Business Mailing Address
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Address Line | 10 VALLEY FROST CT APT K
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City | COCKEYSVILLE
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State | MD
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Zip | 21030-4264
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R246912
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License Number State | MD
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