Provider Demographics
NPI:1669072344
Name:BRADY, SHANTE (FNP)
Entity type:Individual
Prefix:
First Name:SHANTE
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 BLOOMINGBURG RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-8436
Mailing Address - Country:US
Mailing Address - Phone:845-407-7942
Mailing Address - Fax:
Practice Address - Street 1:7256 ROUTE 209
Practice Address - Street 2:
Practice Address - City:WAWARSING
Practice Address - State:NY
Practice Address - Zip Code:12489-2016
Practice Address - Country:US
Practice Address - Phone:845-647-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346677363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care