1952315301 NPI number — SHENAN BRADSHAW DDS MD PA

Table of content: (NPI 1952315301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952315301 NPI number — SHENAN BRADSHAW DDS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHENAN BRADSHAW DDS MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952315301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2708 HENRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-621-1554
Provider Business Mailing Address Fax Number:
336-621-3402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2708 HENRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27405-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-621-1554
Provider Business Practice Location Address Fax Number:
336-621-3402
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STRICKLER
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
336-621-1554

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  5525 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02635 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89016AE , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com