Provider Demographics
NPI:1720343114
Name:BRADLEY, STACY E (MSED)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:E
Last Name:BRADLEY
Suffix:
Gender:
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3816
Mailing Address - Country:US
Mailing Address - Phone:845-548-4600
Mailing Address - Fax:
Practice Address - Street 1:34 ASPEN CT
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3816
Practice Address - Country:US
Practice Address - Phone:845-548-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist