MEDICARE: MARIA BRADSHAW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1235675844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA BRADSHAW

Provider Business Mailing Address
First Line	:	2532 ABNEY AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32833-4301
Country	:	US
Telephone Number	:	407-473-2732
Fax Number	:

Provider Business Practice Location Address
First Line	:	2532 ABNEY AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32833-4301
Country	:	US
Telephone Number	:	407-473-2732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	02/08/2018

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Directions to “ MARIA BRADSHAW ” Practice Location

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