Provider Demographics
NPI:1134735715
Name:BRAXTON, BRADLEY R
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:R
Last Name:BRAXTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SENECA RD # 103
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-4129
Mailing Address - Country:US
Mailing Address - Phone:202-830-6606
Mailing Address - Fax:
Practice Address - Street 1:1900 SENECA RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4129
Practice Address - Country:US
Practice Address - Phone:202-830-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion