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General NPI Number Information
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NPI Number | 1679123400
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Entity Type | Individual
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Provider Name | BRIANA E BRADSHAW MT3869
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Gender | Female
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 12641 NEWFIELD DR
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City | ORLANDO
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State | FL
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Zip | 32837-7433
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Country | US
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Telephone | 321-226-8882
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Fax |
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Provider Business Mailing Address
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Address Line | 12641 NEWFIELD DR
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City | ORLANDO
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State | FL
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Zip | 32837-7433
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Country | US
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Telephone | 407-432-6582
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMT2664
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MT3869
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License Number State | FL
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