NPI |
1972183275 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
BRADLEY |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
SHUCHEMIA |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
NICOLE |
The middle name of the provider, if the provider
is an individual. |
Provider Name Prefix Text |
DR. |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider First Line Business Practice Location Address |
7725 SAINT ANDREWS RD STE 3 |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider Business Practice Location Address City Name |
IRMO |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
SC |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
290632957 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Telephone Number |
7708658600 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
4/11/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
4/11/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
1744P3200X |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
Y |
|
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|
NPI Certification Date |
4/11/2021 |
|