SHANNON GABRIELLE BRADLEY (NPI# 1417124538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417124538 |
| Entity Type | Individual |
| Full Name | SHANNON GABRIELLE BRADLEY |
| Credential | M.D. |
| Practice Address |
330 N 8th Ave E Duluth MN 55805-2024 |
| Practice Telephone | 2187231112 |
| Practice Fax Number | 2185299120 |
| Mailing Telephone | 2187231112 |
| Mailing Fax Number | 2185299120 |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2009-12-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 51866 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICA | 01-37427 | 01 | |
| GROUP HEALTH | 1417124538 | 01 | |
| MN | 1417124538 | 05 | |
| MN | BCBS | 1417124538 | 01 |
| MEDICARE RAILROAD | P00767187 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699336255 | Shannon Bradley | Social Worker | 160 Bethlehem Pike Ste 120, Colmar, PA 18915-9790 | 2019-06-25 |
| 1710256680 | Shannon Bradley | Dental Hygienist | 114 Old Farms Rd, Cheshire, CT 06410-3773 | 2011-12-22 |
| 1053720557 | Shannon Deirdre Bradley | Social Worker | 12590 Whitehall Dr, Suite 1, Fort Myers, FL 33907-4680 | 2014-08-08 |
| 1770908568 | Shannon Poplin Bradley | Art Therapist | 373 Broadway, Ste. B05, New York, NY 10013-3926 | 2014-03-03 |
| 1225082647 | Shannon S Bradley | Obstetrics & Gynecology | 1000 E Rosser Ave, Bismarck, ND 58501-4414 | 2006-05-20 |
| Street Address |
330 N 8TH AVE E |
| City | DULUTH |
| State | MN |
| Zip Code | 55805-2024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942299227 | Roger K. Waage | Family Medicine | 330 N 8th Ave E, Duluth, MN 55805-2024 | 2005-10-19 |
| 1770107294 | Jamie L Hammer | Student in an Organized Health Care Education/Training Program | 330 N 8th Ave E, Duluth, MN 55805-2024 | 2020-06-01 |
| 1164045647 | Lucas T Henningsen | Student in an Organized Health Care Education/Training Program | 330 N 8th Ave E, Duluth, MN 55805-2024 | 2020-05-19 |
| 1851914477 | Jordan R Lindholm | Student in an Organized Health Care Education/Training Program | 330 N 8th Ave E, Duluth, MN 55805-2024 | 2020-05-19 |
| 1053934679 | Nicholas M Loken | Student in an Organized Health Care Education/Training Program | 330 N 8th Ave E, Duluth, MN 55805-2024 | 2020-05-19 |
| 1659994275 | Erin K Traxler | Student in an Organized Health Care Education/Training Program | 330 N 8th Ave E, Duluth, MN 55805-2024 | 2020-05-19 |
| 1558984179 | Owen T Tierney | Student in an Organized Health Care Education/Training Program | 330 N 8th Ave E, Duluth, MN 55805-2024 | 2020-05-19 |
| 1427671049 | Staci K Loken | Student in an Organized Health Care Education/Training Program | 330 N 8th Ave E, Duluth, MN 55805-2024 | 2020-05-19 |
| 1982226072 | Joshua Godding | Student in an Organized Health Care Education/Training Program | 330 N 8th Ave E, Duluth, MN 55805-2024 | 2020-05-12 |
| 1629698915 | Courtney Jo Donahoe | Student in an Organized Health Care Education/Training Program | 330 N 8th Ave E, Duluth, MN 55805-2024 | 2020-04-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356852180 | Peace of Mind of Duluth, Inc. | Community/Behavioral Health | 1000 East 1st Street, Suite 100, Duluth, MN 55805 | 2017-10-19 |
| 1891213419 | Arielle Skalisky | Registered Nurse | 400 E. 3rd Street, Duluth, MN 55805 | 2017-09-04 |
| 1457886400 | Chefrdn, LLC | Dietitian, Registered | 1101 East 4th Street, Duluth, MN 55805 | 2017-04-27 |
| 1962811604 | Claire Elena Kap | Nurse Practitioner | Essentia Health Duluth Clnic, 400 East Third Street, Duluth, MN 55805 | 2014-08-06 |
| 1598196313 | Kelsey Lindsay Putvin | Audiologist | 400 E 3rd St., Duluth, MN 55805 | 2013-12-04 |
| 1639462997 | James F Conniff | Family Medicine | Duluth Family Medicine Clinic, 330 N Eighth Ave E, Duluth, MN 55805 | 2011-05-19 |
| 1215237433 | Bobby Jo Mineheine | Speech-Language Pathologist | 530 East Second St, Polinsky Medical Rehab Ctr, Duluth, MN 55805 | 2010-10-22 |
| 1891004248 | Robin Michelle Warfel | Occupational Therapist | 530 East 2nd Street, Polinsky Medical Rehabilitation Center, Duluth, MN 55805 | 2010-10-04 |
| 1154638716 | Jennifer Chen | Pharmacist | 420 E 1st St Mail Drop 1s3w10, Duluth, MN 55805 | 2010-09-02 |
| 1376858084 | Jennifer Lynn Howard | Pharmacist | 211 West Fourth Street, Center for American Indian Resources, Duluth, MN 55805 | 2010-08-18 |
| Find all providers in zip 55805 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811553084 | Clement Ayanbadejo LLC | Family Medicine | 2282 Meadow Church Rd Ste 200, Duluth, GA 30097-5318 | 2019-05-14 |
| 1902391923 | Young-tae Kim | Family Medicine | 3610 Peachtree Industrial Blvd Ste 100, Duluth, GA 30096-5139 | 2018-06-22 |
| 1659655538 | Primary Care of Atlanta | Family Medicine | 4124 Chattahoochee Trce, Ste 103, Duluth, GA 30097-2147 | 2011-10-10 |
| 1639462997 | James F Conniff | Family Medicine | Duluth Family Medicine Clinic, 330 N Eighth Ave E, Duluth, MN 55805 | 2011-05-19 |
| 1497087126 | St. Luke's Hospital of Duluth | Family Medicine | 6351 E. Superior St., Duluth, MN 55804-2545 | 2010-02-05 |
| 1861729816 | Mark Steven Grimsley | Family Medicine | 1611 Satellite Blvd Ste 3, Duluth, GA 30097 | 2009-11-12 |
| 1154552990 | Clement O Ayanbadejo | Family Medicine | 2282 Meadow Church Rd, Ste 200, Duluth, GA 30097-5318 | 2009-07-28 |
| 1891950457 | Liem Chi Ngo | Family Medicine | 4470 Satellite Blvd, Suite 204, Duluth, GA 30096-8851 | 2008-07-23 |
| 1962663302 | Martin Charles Hinz | Family Medicine | 1150 88th Ave W, Duluth, MN 55808-1505 | 2008-06-18 |
| 1447422506 | Onelio Emilio Perdomo | Family Medicine | 3750 Venture Drive, Suite 130, Duluth, GA 30096-1808 | 2008-03-28 |
| Find all providers in DULUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.