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NPI Code Detail

MEDICARE: BRADLEY SUSHKO RN

MEDICARE: BRADLEY SUSHKO RN
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
1163WP0808XPsychiatric/Mental Health Registered NurseRN2729652FL

General Provider Information

NPI Number : 1548679194
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY SUSHKO RN
Provider Business Mailing Address
First Line : 434 W KENNEDY BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32810-6237
Country : US
Telephone Number : 407-875-3700
Fax Number : 407-532-1051
Provider Business Practice Location Address
First Line : 434 W KENNEDY BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32810-6237
Country : US
Telephone Number : 407-875-3700
Fax Number : 407-532-1051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2014
Last Update Date : 08/19/2014

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