MEDICARE: PAMELA BRADLEY

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1689260648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA BRADLEY

Provider Business Mailing Address
First Line	:	1556 W ROYALTON RD APT 2
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2439
Country	:	US
Telephone Number	:	216-563-2992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1556 W ROYALTON RD APT 2
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2439
Country	:	US
Telephone Number	:	216-563-2992
Fax Number	:

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

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	12/14/2020

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Directions to “ PAMELA BRADLEY ” Practice Location

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