Most Relevant Information
Provider Data
| NPI Number: | 1003521683 |
| Provider Name: | SHANNON M BRADLEY |
| Entity Type: | Individual |
| Taxonomy Code: | 261QR0200X |
| Specialty: | Clinic/Center |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/18/2023 |
| Last Updated: | 01/18/2023 |
Provider Practice Location
4340 NEWBERRY RD STE 104
GAINESVILLE
FL
326072557
Practice Location Phone/Fax
| Phone: | 3523773100 |
| Fax: | 3523771286 |
Provider Mailing Location
232 SW LENVIL LN
FORT WHITE
FL
320384334
Provider Mailing Phone/Fax
| Phone: | 3524943600 |
| Fax: |