Provider Demographics
NPI:1760924716
Name:BRADLEY, SHANTI (MED, MBA, BCBA)
Entity type:Individual
Prefix:
First Name:SHANTI
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MED, MBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46613-2634
Mailing Address - Country:US
Mailing Address - Phone:574-310-4014
Mailing Address - Fax:
Practice Address - Street 1:537 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-2634
Practice Address - Country:US
Practice Address - Phone:574-310-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst