Individual
CHARLES B BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
750 E ADAMS ST, DEPARTMENT OF NEUROLOGY, SYRACUSE, NY 13210-2306
(315) 464-5016
(315) 464-5355
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-5016
(315) 464-7328
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
010159
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01207905
—
NY
Enumeration date
05/04/2006
Last updated
01/23/2009
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