Provider Demographics
NPI:1013203272
Name:SHOSS, BRADLEY LEONE (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:LEONE
Last Name:SHOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-4232
Mailing Address - Country:US
Mailing Address - Phone:321-267-2020
Mailing Address - Fax:321-267-4165
Practice Address - Street 1:730 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4232
Practice Address - Country:US
Practice Address - Phone:321-267-2020
Practice Address - Fax:321-267-4165
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127081207W00000X
MO2015007985207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018716300Medicaid
FLIQ821UMedicare PIN
FL018716300Medicaid
FLIQ821WMedicare PIN
FLIQ821XMedicare PIN
FLIQ821VMedicare PIN