| NPI | 1659962207 |
|---|---|
| Former Name | SHANNON BRADLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0011500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA062225) |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2023-05-05 |