Provider Demographics
NPI:1225825540
Name:BRADLEY, CHEYANNE SIECRRA
Entity type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:SIECRRA
Last Name:BRADLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19536 SHADY LANE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1630
Mailing Address - Country:US
Mailing Address - Phone:313-808-3338
Mailing Address - Fax:
Practice Address - Street 1:19536 SHADY LANE AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1630
Practice Address - Country:US
Practice Address - Phone:313-808-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home