Provider Demographics
NPI:1194992065
Name:BRADY, DEANNA N (DNP, NPP-BC, FNP-C)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:N
Last Name:BRADY
Suffix:
Gender:F
Credentials:DNP, NPP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 KIRKLAND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1462
Mailing Address - Country:US
Mailing Address - Phone:315-853-2125
Mailing Address - Fax:315-853-2125
Practice Address - Street 1:3 KIRKLAND AVE STE 202
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1462
Practice Address - Country:US
Practice Address - Phone:315-853-2125
Practice Address - Fax:315-853-2125
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335541363LF0000X
NY401548363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily